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INDEX 


VOLUME THIRTY 


The Journal 

of the 

Maine Medical Association 



Published monthly at 22 Arsenal Street, Portland, Maine, under the direction of the Council. 

Editorial Board 

Frank H. Jackson, Chairman, Houlton Roland B. Moore, Portland W. J. Renwick, Auburn 

C. Harold Jameson, Rockland E. H. Risley, Waterville S. R. Webber, Calais 




-s 



The Journal 

of the 

Maine Medical Association 


Uolume Thirty Portland, Maine, January, 1939 


No. 1 


Important Considerations in Serum Treatment of Pneumococcus 

Pneumonia* 

By Frederick T. Lord, M.D., Boston, Mass. 


It may be helpful to consider certain mat- 
ters of importance in reaching an attainable 
goal in the specific treatment of pneumococ- 
cus pneumonia. 

Classification of the Pneumonias 

The distinction between lobar pneumonia 
and broncho-pneumonia is at times difficult 
not only clinically, but also at the postmor- 
tem table. Both lesions may be present in 
the same patient. 

It has become customary clinically to refer 
to the pneumonias which do not conform to 
the lobar variety as atypical and include the 
broncho-pneumonias under this term, but the 
classification into lobar and atypical or bron- 
cho-pneumonia is not of practical importance 
and the pneumonias should so far as possible 
be classified in accordance with the inciting 
agent and not with respect to the pathologic 
anatomy. 

It may, in general, be said that pneumo- 
coccus pneumonia is usually lobar and that 
infection with other organisms results in 
broncho-pneumonia. 


The mistake has frequently been made of 
regarding lobar pneumonia only as amenable 
to antipneumococcic serum therapy and dis- 
missing broncho-pneumonia from considera- 
tion. It should be appreciated, however, that 
any one type of pneumococcus may cause 
either lobar or broncho-pneumonia. To be 
sure, the individual types of pneumococci 
vary in the frequency with which they are 
responsible for one or the other form of 
pneumonia. Thus, Type 1 and Type 2 pneu- 
mococci cause lobar pneumonia in a large 
proportion of the cases, but may also cause 
broncho-pneumonia. The proportion of those 
with broncho-pneumonia rises among pneu- 
mococcus pneumonias due to other types and, 
as shown by Finland (Annals Int. Med. 10: 
1531, April, 1937) may reach one-third to 
one-half of the cases. 

Early Diagnosis of Pneumonia 

In view of the importance of the pneumo- 
coccus as a cause of both lobar pneumonia 
and broncho-pneumonia, the differentiation of 
the one from the other has lost much of its 


* Prepared for publication in The Commonhealth, Massachusetts Department of Public Health, and 
presented at the meeting of the Penobscot County Medical Association, Bangor, Maine, Nov. 15, 1938. 


2 


The Journal of the Maine Medical Association 


significance. Lobar pneumonia is, however, 
of greater relative importance, because of the 
infrequency with which other than pneumo- 
cocci are the cause and the high incidence of 
Types 1 and 2 as inciting agents. 

It is fortunately easy to recognize lobar 
pneumonia at its inception in a large propor- 
tion of the cases. In typical instances, there 
is often the history of a preceding cold. The 
onset is commonly abrupt with coincident 
pain in the side, cough and chill or chilliness, 
rapid elevation of temperature and rusty 
sputum. This complex of initial symptoms 
is incomplete in a small proportion of cases. 
Definite physical signs are not to be expected 
early in the disease and two to three days 
may elapse before there is definite evidence 
of consolidation. In rare instances, examina- 
tion by other means than x-ray may be nega- 
tive throughout the illness. 

Broncho-pneumonia as a pneumococcus in- 
fection, is usually due to Type 3 and still 
higher types of the pneumococcus. Primary 
broncho-pneumonia is for the most part a 
disease of infancy and the first four years of 
life. After this age, primary broncho-pneu- 
monia is uncommon but may be expected in 
a proportion not exceeding ten per cent. The 
essential factor in the production of secon- 
dary broncho-pneumonia is the extension 
downward of an infecting agent and the 
types of pneumococci or other organisms nor- 
mally present in the upper parts of the 
respiratory tract are concerned in the pro- 
duction of the disease. Pneumococci are 
found in the upper respiratory tract in a 
large proportion of normal persons. The 
carrier state may be transient, intermittent 
or chronic. Among normal individuals with- 
out a history of recent exposure to a patient 
with lobar pneumonia, the pneumococci har- 
bored in the upper respiratory tract are rare- 
ly Type 1 or Type 2 and more often Type 3 
and still higher types. 

In primary pneumococcus broncho-pneu- 
monia, there is, as with lobar pneumonia, 
usually the history of an acute respiratory 
infection such as accompanies a cold. The 
onset is less abrupt than with lobar pneu- 
monia. An initial chill and pain are less 
often present. The sputum is usually muco- 


purulent, occasionally rusty. In cases in 
which pneumococcus broncho-pneumonia is 
secondary and occurs in the course of other 
serious illnesses, after childbirth, during the 
puerperium, or after surgical operation, the 
onset may be insidious and the pneumonia 
discovered only in the course of a routine 
physical examination. The usual occurrence 
of broncho-pneumonia as a complication of 
an existing respiratory infection, the insidi- 
ous onset, irregular course and frequent ab- 
sence of definite physical signs make the 
diagnosis of the disease difficult and at times 
impossible without resort to x-rav examina- 
tion. In the absence of this means of exam- 
ination, it often happens that for a time it 
can only be regarded as probable from the 
attendant circumstances and the symptoms 
or signs. It should be appreciated that bron- 
cho-pneumonia practically always complicates 
capillary bronchitis and may be assumed to 
be present in the disease even in the absence 
of more definite indications. Broncho-pneu- 
monia should also be suspected, in the course 
of an acute bronchitis, when the fever per- 
sists longer than a few days, or when rales 
are localized and persist in one place longer 
than elsewhere, or when, without change in 
the local signs, there is an abrupt increase in 
toxic symptoms and elevation of tempera- 
ture, pulse and respiration. As there are no 
distinctive features of the different types of 
pneumococcus infection, resort must be made 
to the laboratory for the determination of 
the type of pneumococcus infection in each 
case of pneumonia. 

Types or Pneumococci in Pneumococcus 
Pneumonia 

The incidence of the various types of 
pneumococci vary at different times and dif- 
ferent places. In adults under ordinary cir- 
cumstances, infection with Type 1 pneumo- 
coccus is more common than with other types. 

Among 3,066 cases of pneumococcus pneu- 
monia (including both lobar pneumonia and 
broncho-pneumonia) in adults, investigated 
by Bullowa & Wilcox (Arch. Int. Med. 59 : 
394, March, 1937) the average incidence of 


Volume Thirty , No. I Important Considerations in Serum Treatment of Pneumococcus Pneumonia 


the types most frequently encountered in 
adults was as follows : 


Pneumococcus Percentage distribution 
type in 3,066 cases 


I 23.7 

III 9.7 

II 8.4 

V 7.5 

VIII 7.3 

VII 6.3 

IV 5.8 

XIV 2.8 

IX 2.2 

XVIII 2.1 


Typing of Pneumococci 

In view of the importance of early specific 
treatment, determination of the type of in- 
fection should he made at the earliest pos- 
sible moment. 

Type determination is more readily made 
by the examination of sputum than by other 
means. The specimen of sputum should 
come from the lung with as little admixture 
of saliva or nasal secretion as possible. Rusty 
or blood-streaked material is most likely to 
show the inciting agent. Small amounts of 
sputum suffice for typing bv the Xeufeld 
method, culture on blood agar and, if neces- 
sary, mouse inoculation. It is no longer nec- 
essary to obtain the large amounts which 
were required for typing by the precipitation 
method. A fresh specimen should be sent at 
once to the nearest laboratory equipped for 
typing. Tt should be collected in a small, 
clean, dry and preferably sterile, wide- 
mouthed bottle. Clear glass facilitates the 
selection by the technician of suitable por- 
tions of the specimen. As drying is to be 
avoided, cardboard sputum boxes are less ser- 
viceable and it is best to collect the sputum 
in the special containers available through 
local boards of health. Xo antiseptic should 
be added to the specimen, as the determina- 
tion of type may depend on the presence of 
living organisms. Tuberculosis sputum out- 
fits should not be used as they contain car- 
bolic acid. 

Sputum can be obtained from adults in 
most cases if the physician is sufficiently in- 
sistent. When no sputum is available, the 
type of pneumococcus infection may be de- 


termined by the examination of material ob- 
tained from the pharynx on a sterile cotton 
swab. This is replaced in the sterile tube and 
sent at once to the laboratory where particles 
of sputum may be removed by twirling the 
swab rapidly back and forth in a small 
amount of broth. Application of the Xeufeld 
method to the sediment obtained by centri- 
fuging at high speed may permit identifica- 
tion of the type of pneumococcus at once or 
incubation of the broth or mouse inoculation 
with the sediment may give a positive result 
after the lapse of some hours. 

The limited distribution of Types 1 and 2 
pneumococci with rare exception to patients 
with pneumonia or their contacts may be 
taken to indicate that the finding of one or 
the other in the sputum of a patient with 
pneumonia means that the organism is al- 
most certainly the cause of the infection. On 
the other hand, the finding of one of the 
higher types commonly present in the normal 
mouth may mean that the causative organism 
has been missed and the typing should at 
once be repeated on another specimen of 
sputum. 

Importance of Blood Cultures 

A blood culture should be taken as a rou- 
tine in all cases and may be the means of 
making a diagnosis of type when other meth- 
ods fail. Blood cultures are, however, posi- 
tive in only a minority of cases. In general, 
about one-quarter of those with Type 1 and 
one-third of those with Type 2 pneumococcus 
pneumonia develop bacteriemia. The blood 
culture is, thus, more likely to be negative 
than positive and there is the further disad- 
vantage in the necessity of making the diag- 
nosis of type by this means that it entails 
loss of time in waiting for the growth of 
organisms. 

In specifically treated cases, a blood cul- 
ture should be taken immediately preceding 
the first injection of serum and as occasion 
may require throughout the illness. The in- 
formation derived from the blood culture is 
of great importance in treatment. In Type 
1 and Type 2 cases, not treated with serum, 
the fatality rate is four to five times as high 
in those with as in those without bacteriemia. 
The high death rate in bacteriemic cases may 


The Journal of the Maine Medical Association 


4 


he much reduced by serum treatment, but 
much larger doses are required. If the blood 
cultures taken before serum is given are posi- 
tive, or, if negative, and the progress of the 
case is unsatisfactory, it is important to con- 
tinue to take blood cultures at intervals of 
twenty-four hours or more often. 

Failure to determine the presence of bac- 
teriemia in serum-treated cases deprives the 
physician of one of the most important 
guides to dosage. In the earlier Massachu- 
setts cases, of 1341 Type 1, 2 or 5 cases 
(1931-37) blood cultures were taken in only 
635, or 47.4 per cent. During the period in 
which these cases occurred, facilities for tak- 
ing blood cultures were for the most part 
available only in the larger hospitals. In 
February, 1938, Chadwick (Serum Treat- 
ment of Pneumonia, H. E. J. of Med. 218 : 
Ho. 8, 366, Feb. 24, 1938) announced that 
blood culture outfits could be obtained from 
laboratories approved by the State Depart- 
ment of Public Health. After the addition 
of the patient’s blood to the culture medium, 
the outfit should be returned at. once to the 
same laboratory. Postal regulations do not 
permit the mailing of these blood cultures, 
and the outfits must therefore be sent by 
messenger. 

It is encouraging to note that in the later 
Massachusetts experience* (1937-38) of 550 
Types 1, 2, 5, 7 and 8 cases, blood cultures 
were taken in 326, or 59.3 per cent. In this 
group, though the proportion of those on 
whom blood cultures were taken has risen 
about twelve per cent over that in the earlier 
group (1931-37), lack of information regard- 
ing bacteriemia in 40 per cent of the cases 
and consequent uncertainty regarding the 
necessary dosage of serum may be regarded 
as a serious obstacle to adequate specific 
treatment. 

Tn consequence of the importance of deter- 
mining the presence or absence of bacteri- 
emia, blood culture medium is part of the 
necessary equipment for the treatment of 
pneumonia. With the patient in a hospital 
and the laboratory nearby, culture medium 
in cotton-plugged flasks can be used. For use 
in the home, culture media in rubber-stop- 
pered bottles covered with a gauze cotton 

* For this and other data dealing with the 1937- 
38 series, I am indebted to Dr. Frank R. Philbrook. 


hood are available through approved labora- 
tories. Five cubic centimeters of the pa- 
tient’s blood should be added to the 50 c. c. of 
culture fluid. Caution should be exercised to 
avoid contamination of the medium in han- 
dling. Before blood is obtained, the stopper 
should be loosened without removing the 
hood. For the introduction of blood, the 
bottle is inclined at an angle of about 45 
degrees, the hood and stopper together lifted 
directly upward, blood ejected from the 
syringe and the hood and stopper replaced. 
Contamination especially with staphylococci 
is likely to occur if the stopper itself is 
handled or if the fringe of the hood is drawn 
across the mouth of the bottle. In the pres- 
ence of pneumococci in the sample of blood, 
growth may be expected after eight to twelve 
or more hours, and the type determined by 
the Heufeld method. 

Results in the Massachusetts Series 

The case fatality rate of Type 1 pneumo- 
coccus pneumonia untreated with serum is 
approximately 30 per cent and of Type 2 
about 43 per cent. Of 1,451 Type 1 cases in 
the Massachusetts Pneumonia series, which 
were treated with serum within the first four 
days of the illness, 194, or 13.3 per cent died. 
Of 368 Type 2 cases similarly treated, 80, or 
21.7 per cent died. The experience in Massa- 
chusetts and elsewhere has demonstrated that 
specific treatment can be successfully used by 
physicians in general practice. 

The importance of the time element is em- 
phasized by the experience in Massachusetts. 
Of 1,205 Type 1 cases treated during the 
first three days, 145 (12 per cent) died, and 
of 246 treated on the fourth day, 49 (20 per 
cent) died. If patients with Type 1 pneumo- 
coccus pneumonia are treated within the first 
twenty-four hours, the fatality rate may be 
reduced to 5 per cent.* 

Results and Dosage of Serum 

It should be appreciated that variation in 
individual requirements make it impossible 
to treat patients by rule of thumb. Tn esti- 
mating the required dosage, reliance must be 
placed chiefly on the results obtained in large 

* Cecil, R.: J. A. M. A. 108:689, Feb. 27, 1937. 


Volume Thirty, No. I Important Considerations in Serum Treatment of Pneumococcus Pneumonia 


5 


groups of cases. Decrease in the fatality 
rates in serum-treated cases below the rates 
to be expected without such treatment, is the 
most important index of the degree of success 
in estimating dosage. The experience in 
Massachusetts has an important bearing on 
this problem. Owing to the small number of 
cases due to infection with other than Types 
1 or 2 pneumococcus, the results in these two 
groups only will be considered. 

In 956 Type 1 cases (1931-37) treated 
with serum of known potency during the first 
four days of the illness, there were 134 
deaths, or 14 per cent. The average total dos- 
age for each case in this group was 87,569 
units. In 408 later (1937-38) Type 1 cases 
treated with serum of known potency during 
the first four days, 49, or 12 per cent, died. 
The estimated average total dosage of serum 
in these cases was 109,900 units. 

In appraising these results in Type 1 cases 
in the Massachusetts series, it is encouraging 
to note that there has been a reduction from 
an expected death rate of 30 per cent to 14 
per cent and 12 per cent, respectively, as 
noted above in the two groups, or well over a 
half. 

In 259 Type 2 cases (1931-37) treated 
with serum of known potency during the first 
four days, there were 57 deaths, or 22 per 
cent. The average total dosage for each case 
in this group was 92,718 units. In 87 later 
(1937-38) Type 2 cases, 17, or 19.5 per cent, 
died, and the estimated average total dosage 
was 110,800 units. As the expected fatality 
rate in Type 2 cases without serum treat- 
ment is 43 per cent, there has been a reduc- 
tion of well over a half. 

Changes of Policy with Pespect to the 
Distribution op Serum 

The results presented in Type 1 and 2 
cases are based on cases treated within the 
first four days of the illness. This restriction 
in the use of serum supplied by the State 
Department of Public Health was removed 
in March, 1937 (Chadwick, J. A. M. A. 109 : 
1926, Dec. 4, 1937). Though the benefits of 
serum diminish as the days go by after the 
onset, no time limit can be set beyond which 
serum is ineffective. Patients should not be 


deprived of specific treatment even though 
its use is begun late in the illness. 

The amount of serum dispensed by the 
Department of Public Health for the treat- 
ment of a patient with pneumonia is no 
longer restricted. (Circular, Department of 
Public Health, Division of Biologic Labora- 
tories, May 3, 1937.) 

Dosage of Serum 

It is not to be expected that even under 
the most favorable circumstances every pa- 
tient with pneumococcus pneumonia can be 
saved, but the reduction in the fatality rate 
in the Massachusetts Series falls short of an 
attainable goal. Among the avoidable causes 
of failure in specific treatment are a delay 
in beginning treatment, insufficient dosage, 
too long intervals between doses, and lack of 
attention to the requirements of individual 
patients. 

Regarding delay in treatment, it is encour- 
aging to note that while in the first 1,043* 
Type 1 cases, 17.5 per cent were treated on 
the first day, 36.8 per cent on the second, 28 
per cent on the third and 17.4 per cent on 
the fourth, in the last 408 cases (1937-38) 
the corresponding percentages were 23, 40, 
21 and 15.6 per cent. 

It is to be hoped that in subsequent cases, 
a very much larger proportion will be treated 
on the first day of the disease. 

It is desirable to give the necessary 
amount of antibody not only as early as pos- 
sible, but within as short a time as is consis- 
tent with safety. The fatality rate in Type 1 
cases of 12 per cent, as in the 1937-38 series, 
can doubtless be lowered by more careful 
attention to the individual needs of the 
patients. 

Suggestions regarding dosage are given in 
detail on the blue sheet which is distributed 
with the serum. The importance of certain 
of those recommendations may be empha- 
sized. At present, in Massachusetts, it is 
recommended, subject to the precautions 
which must be exercised with respect to 
treatment with alien serum, that patients 
with Type 1 pneumococcus pneumonia be 

* Including 956 cases treated with serum of 
known potency and 87 cases with serum of un- 
known potency. 


6 


The Journal of the Maine Medical Association 


given an initial dosage of at least 60,000 
units, with Types 2, 5, or 8 at least 100,000 
units, and with Type 7 at least 60,000 to 
90,000 units. This is only the initial course 
of injections and does not constitute the full 
initial dosage in all cases. 

To secure the initial dosage indicated 
above, all the serum is not given at one time. 
The serum is usually administered at two- 
hour intervals until the dosage decided upon 
has been given. The customary amount of 
the first injection is 2 c. c., the second the 
remainder of the contents of the vial, the 
third the contents of two vials, and subse- 
quent injections the contents of three or more 
vials. The amount of serum injected at one 
time should not exceed 50 c. c. The introduc- 
tion of the words at least before each amount 
in the paragraph above is to be regarded as a 
warning to give a larger initial dosage in 
severe cases and to err rather on the side of 
too much than too little serum. Then, too, it 
must be appreciated that these figures refer 
only to the dosage in the initial course of in- 
jections and do not imply that the specific 
treatment should stop here. In fact, the use 
of the teriji initial dosage is of itself an in- 
timation that further dosage may be desir- 
able. 

In the scheme outlined, it is recommended, 
furthermore, that under certain unfavorable 
circumstances, such as the inauguration of 
treatment after the third day, with a patient 
over 40, with pregnancy or during the first- 
week of the puerperium, multiloba r involve- 
ment and pneumococcus bacteriemia, that 


the dosage of serum in the initial course of 
injections be at least doubled. 

Having followed the directions thus far, 
in many cases only a beginning has been 
made in treatment and subsequent dosage 
must be estimated in accordance with the 
needs of each case. Here again it is better to 
err on the side of safety and give too much 
rather than too little serum. Additional in- 
dividual injections of 40,000 to 60,000 units 
should be given at intervals of every three to 
four hours, in all severe cases and in any case 
if the temperature does not fall below 102 
degrees F. by rectum within twelve hours of 
beginning serum treatment, or having fallen, 
it again rises above this level, if bacteriemia 
has been demonstrated regardless of the clini- 
cal course, or if there is evidence of a spread- 
ing lesion. In this group, it is desirable that 
the serum be given in the larger doses and 
for a longer period in the presence of two or 
more of the circumstances mentioned above. 

The amount of antibody necessary for suc- 
cessful specific treatment varies within wide 
limits in different cases. The suggestions 
with respect to dosage should be taken to in- 
dicate that there is wide latitude in the sched- 
ule and that the dosage must be adjusted to 
the needs of the individual patient. 

If the patient fails to improve within 
twenty-four to forty-eight hours after begin- 
ning specific therapy, it is desirable to send 
another specimen of sputum for typing, as a 
mistake in bacteriologic diagnosis is possible. 

Failure to improve after seventy-two 
hours, suggests the presence of some compli- 
cation such as empyema. 


Volume Thirty, No. I Impressions Gained from the Recent National Health Conference 


Impressions Gained from the Recent National Health Conference 

in Washington* 

W. F. Braasch, M. D., Rochester, Minnesota. 


In the first place the gathering in Wash- 
ington was no conference at all — at least in 
the generally accepted meaning of that term. 
As I understand it, the term conference im- 
plies an attempt to arrive at a solution of 
some problem by a group of individuals who 
might have different opinions but who pos- 
sess authoritative information concerning the 
subject in hand. The problem should have 
free and frank discussion from all sides in 
order to obtain as much information as pos- 
sible, and the only objective in mind should 
be to arrive at conclusions which would he 
mutually agreeable. 

Cleverly Pre-arranged 

Instead of a conference, a cleverly pre-ar- 
ranged program was set up, with the sole ob- 
jective of publicizing and supporting a pro- 
gram of health reform inspired by federal 
officials. Invited to the “conference” was a 
carefully selected group of some 150 indi- 
viduals, most of whom were known because 
of their so-called liberal views toward medi- 
cal care, and who had either written or spok- 
en in behalf of these views. In the group 
were men and women with a wide assortment 
of occupations, including many social and 
welfare workers, magazine editors, newspa- 
per men, and labor union representatives. 

To give it an atmosphere of fairness, a 
small group of physicians representing the 
American Medical Association was invited. 
They were quite overwhelmed by the mass 
of hostile propaganda — and for all practical 
purposes, they might better have stayed at 
home. Conspicuous by their absence were 
representatives of banking, investment activ- 
ities, and of industry and manufacturing , 
ivho might have been interested in the finan- 
cing of the vast expenditures involved. 
Heither were there any economists or educa- 
tors who had ever been guilty of entertaining 
any theories which might be called conserva- 
tive or reactionary. 


Discussions Released in Advance 

Much of the time scheduled for the pro- 
gram of the conference was spent in reading 
the report and recommendations of the 
governmental health forces. These had been 
typed previously and had been read and stud- 
ied by some of the delegates present. They 
also had been released by previous arrange- 
ment for national newspaper publicity from 
day to day. The discussion which followed 
was largely pre-arranged and the remarks 
made by many of those who took part in the 
discussion were also previously written and 
dated for publication. 

For the most part those who were called 
upon to discuss the problem were sympathet- 
ic with the government program and in most 
cases urged that even more radical steps be 
taken. 

Emotional Well-wishing 

It is difficult to understand the psychology 
of many of those who were assembled in the 
conference. One fact stands out above every- 
thing else, however, and that is that when it 
comes to opinions regarding the care of 
health, many intelligent people base their 
ideas more on emotion than logic. One won- 
ders how intelligent men and women could 
make statements which were largely without 
factual basis and governed purely by emo- 
tional well-wishing. 

It was surprising as well as discouraging 
to hear well-meaning representatives of such 
supposedly well-informed organizations as 
the Farm Bureau Federation, Parent-Teach- 
ers’ Association, General Federation of 
Women’s Clubs, and League of Women Vo- 
ters get up and urge various phases of health 
socialization without acquainting themselves 
with all phases of the problems involved. It 
is to be hoped that these splendid organiza- 
tions, usually well-informed and unbiased, 
will in the future get their information on 
matters of health from all sources, including 


* Reprinted from Minnesota Medicine, September, 1938, Volume 21, Page 659. 


8 


The Journal of the Maine Medical Association 


that storehouse of information available at 
the headquarters of the American Medical 
Association. 

Lay Confusion 

One feature of much of the laymen’s bar- 
rage was a curious confusion of the indigent 
with the low income groups. Apparently 
many of the lay speakers failed to realize the 
fundamental differences in the problems in- 
volved in their health supervision. They did 
not seem to know that the health of the in- 
digent was supposed to be under municipal, 
state, or federal control. It was rather ironi- 
cal to hear their outspoken criticism of the 
failure of government agencies to look after 
this group properly when governmental con- 
trol was supposed to be the objective of their 
arguments. 

Doctor Ridiculed 

The physician present was placed in a cu- 
rious position. One almost felt like a social 
outcast in the group, and a guilty conspirator 
to block justice and progress. We were placed 
in the role of selfish, narrow-minded individ- 
uals, having no vision or ability to sense re- 
form and incapable of managing affairs of 
health as they should be managed. A jibe or 
sally at the unfortunate doctor was greeted 
with a round of laughter or applause. On the 
other hand, a calm statement showing what 
the physician or medical societies had al- 
ready done and were trying to do to improve 
medical care received scant attention or was 
greeted with silence. 

Sensational Publicity 

Another feature of the conference was the 
sensational publicity of the proceedings by 
the daily press. Liberal space was given to 
the Federal Health program as released by 
the Interdepartmental Committee. Only the 
sensational features of the discussion were 
publicized, which were largely radical and in 
support of the proposed reforms. The re- 
marks made by Dr. West and Dr. Abell, 
which stated that the medical profession was 
in sympathy with some features of the fed- 
eral program, while others were regarded as 
objectionable, and their statements showing 


how much already had been accomplished by 
physicians along these lines, received only 
abbreviated notice in the press. The con- 
tribution of Dr. Cabot, in which he ridiculed 
the present methods of medical care, and the 
well merited rebuke by Dr. West, received 
more headlines than any other feature of the 
entire conference. 

Unfortunately, the introductory remarks 
made by Dr. Cabot received but little notice 
but, in all fairness, should be repeated. Be- 
fore reading his paper he spoke as follows: 
“I wish to have it distinctly understood that 
the views I hold in this controversy are my 
own and in no way represent the attitude 
of the Mayo Clinic.” Instead of publicizing 
this statement, the newspapers gave the im- 
pression that Dr. Cabot spoke as a repre- 
sentative of the Clinic, which was quite con- 
trary to the truth. 

A Few Tricks of Their Own 

It must be said that the skill with which 
the proponents of medical socialization have 
inoculated an increasing circle of the laity 
with their ideas is most impressive. They 
have learned all of the tricks practiced by 
other governmental activities marvelously 
well and added a few of their own. The way 
otherwise intelligent laymen mouthed the oft- 
repeated but incorrectly founded statements 
concerning lack of medical care is a startling 
illustration of what skillful propaganda can 
accomplish. 

Purpose 

The purpose of the conference was dis- 
cussed in the introductory remarks of Miss 
Josephine Roche, the able General Chairman 
of the Interdepartmental Committee. The 
federal program for medical reform was dis- 
cussed in general terms by its progenitor, Dr. 
Parran, Surgeon General of the United 
States Public Health Service. His senten- 
tious remark to the effect that medical care 
promises to be the main issue, both political 
and social, before the American people in the 
immediate future would seem to give clear 
warning of the purpose of the government to 


Volume Thirty, No. I Impressions Gained from the Recent National Health Conference 


invade the promising field of medical care, 
both therapeutic and preventive, and use it 
for any political advantage that it may pos- 
sess. The report of the Technical Committee 
and the agenda of the conference have been 
published in detail in recent issues of the 
Journal of the American Medical Associa- 
tion. A synopsis of the recommendations 
made, with a few random comments, may be 
of interest. 

Program 

The Technical Committee’s study of health 
and medical services in the United States in- 
dicates that deficiencies in the present health 
services fall into four broad categories : 

1. Preventive health services of the nation as a 
whole are grossly insufficient. 

2. Hospital and other institutional facilities are 
inadequate in many communities, especially in 
rural areas, and financial support for hospital 
care and for professional services in hospitals 
is both insufficient and precarious, especially 
for services to people who cannot pay the costs 
of the care they need. 

3. One-third of the population, including persons 
with or without income, is receiving inade- 
quate or no medical service. 

4. An even larger fraction of the population suf- 
fers from economic burdens created by illness. 

The Committee submitted a program of 
five recommendations to meet these problems 
which are as follows : 

I. Expansion of public health and maternal and 
child health services. 

A. Expansion of general public health services. 
It is recommended that Federal participation in the 
program of preventive health service should be in- 
creased and, furthermore, that Federal participa- 
tion be increased to promote a frontal attack, to 
(1) eradicate tuberculosis, venereal disease and 
malaria; (2) control mortality from pneumonia 
and cancer; and. (3) promote mental and indus- 
trial hygiene. 

B. Expansion of maternal and child health 
services. This includes provisions for medical and 
nursing care of mothers and newborn infants; 
medical care of children; services for crippled 
children; consultation services of specialists; and 
more adequate provision for postgraduate training 
of professional personnel. It includes, also, rec- 
ommendations for the establishment of numerous 
health and diagnostic centers for these purposes. 
The total cost of taking care of the recommenda- 
tions under A. is estimated at $200,000,000, and 
under B. $165,000,000, or total of $365,000,000. 

II. Expansion of Hospital Facilities. The Com- 
mittee found hospital facilities inadequate and rec- 
ommends a ten-year program providing for expan- 
sion of the nation’s hospital facilities by provision 
of 360,000 beds, and by construction of 500 health 
and diagnostic centers. Averaged over a ten-year 
period the total cost of such a program was esti- 
mated at $146,000,000. 


III. Medical Care for the Medically Needy. 

The Committee finds that, based on a National 
Health Survey, one-third of the population which 
is in the lower income levels is receiving inade- 
quate general medical service. This applies to (1) 
persons without income supported by general re- 
lief; (2) those supported through old age assist- 
ance or work relief, and (3) families with small 
incomes. Current provisions to assist these people 
by any local and voluntary organizations and by 
physicians are not equal to meet the need. The 
Committee recommends that the Federal govern- 
ment, through grants-in-aid to the states, imple- 
ment the provision of public medical care to these 
groups. It is estimated that on the average ten 
dollars per person annually would be required to 
meet the minimum needs for essential medical 
care, hospitalization, and emergency dentistry. 
This part of the program would probably reach an 
estimated level of $400,000,000 annually. 

No statement was made as to how this money 
was to be spent, nor to whom it would go. 

IV and V include a general program for medi- 
cal care and insurance against loss of wages dur- 
ing sickness. The Committee states that without 
great increase in the total national expenditure 
the burden of sickness cost can be greatly reduced, 
through appropriate devices to distribute these 
costs among groups of people and over periods of 
time. The cost of the insurance and allied pro- 
gram has been estimated at approximately $2,600,- 
000,000 annually. 

To finance the program, two sources of funds 
could be drawn on; (a) general taxation or special 
tax assessment; (b) specific insurance contribu- 
tions. The Committee recommends consideration 
of both methods. 


Cost: 30 Billions 

The role of tlie Federal Government would 
be principally that of giving financial and 
technical aid to the states in the development 
of procedures largely of their own choice. 
The maximum annual cost to Federal, State 
and local governments of all recommenda- 
tions, other than the insurance features, is 
estimated at about $850,000,000. Over a pe- 
riod of ten years this would mean $8,500,- 
000,000. If compulsory health insurance is 
added to this at an estimated annual expen- 
diture of $2,600,000,000, the ten-year expen- 
diture for this and the other program would 
amount to more than thirty billion dollars. 

The manner in which the inspired health 
reformers referred, without batting an eye, 
to the expenditure of billions was most im- 
pressive. If the government is actually called 
on to meet these demands, it will make the 
cost- of old age and unemployment insurance 
look like a mere side issue. No doubt the al- 
leged lack of business ability and financial 
sense in the medico accounts for his inability 
to disregard, in like manner, the stupendous 
sums involved. 


IO 


The Journal of the Maine Medical Association 


Some Are of Value 

Although it would he impossible to make a 
detailed review of these proposals in these 
columns, their comparative value may be 
summed up as follows : some of the recom- 
mendations are well founded and should 
prove to be of benefit to public health ; others 
are either unnecessary or are not practical ; 
and the rest would do more harm than good. 
Many features of those recommendations 
which are largely of a preventive nature will 
meet with approval by the medical profes- 
sion, provided that the program can be car- 
ried out in close cooperation with and under 
the control of medical organizations. 

Would Alter Medical Practice 

Many of the recommendations which 
would alter if not transform the practice of 
medicine require careful study and investi- 
gation before they can be endorsed by the 
medical profession. Outstanding among 
these proposals may be mentioned the estab- 
lishment of at least 500 health centers 
throughout the land for the control of tuber- 
culosis, cancer and other lesions, and several 
thousand centers for the control of child 
health. These centers will, in order to be com- 
plete, necessarily require the services of a 
host of physicians in various capacities as 
specialists, technicians, and administrative 
officers, which, together with allied dental, 
nursing and technical services, will lead to 
complete modification of the present meth- 
ods of medical practice. 

It would he quite impossible for any na- 
tionwide plan of this hind to escape eventual 
lay and political control, with leveling and 
deterioration of service, not to mention pro- 
fessional regimentation and suppression of 
individual professional initiative. 

Based on WPA Figures 

Most of the information and recommenda- 
tions made in the Report of the Technical 
Committee and most of the statements made 
by the three introductory speakers on the 
program regarding the incidence of illness 
and lack of medical care were based on sta- 
tistics obtained from the National Health 
Survey. This survey was made largely by 


WPA workers over a period of six months 
under the supervision of the Public Health 
Service. The resulting statistics are based on 
a house to house canvass of 740,000 urban 
and 36,000 rural families. Much of the re- 
ported illness and types of disease had no 
medical confirmation. The fact that the diag- 
nosis and evaluation of reported disease was 
made without medical training would in it- 
self make the survey of doubtful value. 

A review of the survey reveals many other 
data which might be questionable. For ex- 
ample, statements made by persons on relief 
or with low incomes as to disease being the 
cause of their economic status may be biased. 
The frequency and severity of illness report- 
ed by this survey so greatly exceeds that re- 
ported by the Committee on Cost of Medical 
Care and that of the Metropolitan Life In- 
surance Company, and differs widely in so 
many other respects with these surveys, that 
the accuracy of the entire report is open to 
question. 

Open to Question 

Many broad conclusions were made from 
the survey statistics which are open to ques- 
tion, such as the statement that 40 per cent 
of the persons canvassed were receiving too 
low an income to maintain them in a healthy 
condition. This certainly is not true in most 
sections of the country — and even if it were 
true the problems involved are more econom- 
ic than medical. The situation would be 
changed very little by giving this group more 
medical care without correcting the economic 
factors. 

The statistics purporting to show the per- 
centage of individuals who receive no medical 
care are not even probable. Most similar 
studies have shown that about 50 per cent of 
the population suffer no illness requiring 
medical care during any given year. The sta- 
tistics in regard to relative need and distribu- 
tion of hospitals in relation to the population 
have been proved to be quite erroneous by the 
careful survey carried out under the super- 
vision of the Council on Medical Education 
and Hospitals. These are random examples 
but they show how statistics can be made to 
fit preconceived ideas and used to prove them. 


Volume Thirty, No. I 


A New Antigen for the Diagnosis of Trichinosis 


II 


Said Dr. Goldwater 

Space will not permit a detailed review of 
the discussion which followed the reading of 
the various sections of the Committee Report. 
I have already indicated the general tenor 
of the remarks of those who took part. 
Among those few who discussed the problems 
from a more conservative angle was Dr. 
Goldwater of ISTew York City and his re- 
marks deserve special consideration. Unfor- 
tunately, space permits only a few quotations 
from his address, which are as follows : 

“The objectives stated by spokesmen for the In- 
terdepartmental Committee are commendable, but 
the program submitted arrives at its results by 
methods of calculation that are too simple to be 
reliable. Neglected illness is not always converti- 
ble by means of money grants or administrative 
measures into illness effectively prevented or 
cared for. A substantial fraction of increased gov- 
ernment expenditure is almost certain to be used 
for more custodial care. 

“Sincere enthusiasts who, thirty years ago, were 
sure that tuberculosis would be abolished by 1935, 
are still writing optimistic tuberculosis programs 
in glamorous terms of hundreds of fresh millions 
of dollars. 

Self-help Preferable 

“In health-protection, self-help is preferable to 
outside aid; government intervention in medicine 
is desirable as a last, not a first, resort. 

“For similar reasons the efforts of county medi- 
cal societies and of medical cooperatives sponsored 
by ethical physicians should be encouraged. These 
efforts are of primary importance in relation to 
home care, which is of concern to a greater num- 
ber of individuals than actual or theoretically re- 
quired institutional care. 


“Medical care should be locally, rather than 
nationally, administered. The effective and eco- 
nomical administration of medical aid for the 
masses by huge Federal agencies is well nigh im- 
possible. 

The vigorous defense by Dr. Eishbein of 
the methods employed by the American Med- 
ical Association and organized medicine, ex- 
cathedra and also in the abbreviated time 
allotted him for discussion, should be men- 
tioned. Also among those who contributed 
from the conservative side Dr. McCormack 
should be mentioned and Dr. Paullin, Father 
Schwitalla., Dr. Feeder, and Dr. Meyer. 

In the summing up of the evidence for the 
plaintiffs by E. E. Witte, Professor of Eco- 
nomics, University of Wisconsin, the liberal 
cohorts were urged to press their cause even 
more than in the past. He pointed out that 
in order to obtain real progress action by the 
separate states would be necessary. He pre- 
dicted that the honor of being the first state 
to support a health insurance law would 
probably go to Hew York, but that the im- 
mediate opportunities in Wisconsin appeared 
most promising. It would seem that our 
brethren in Wisconsin will be in for a hard 
winter and it is up to medical organizations 
in the surrounding states to give them all the 
support, both moral and actual, that we can 
muster. 

W. F. Braasch, M. D. 


if * 


A New Antigen for the Diagnosis of T richinosis 


A new type of antigen — By Associate 
Zoologist John Bozicevich — of the Rational 
Institute of Health (Public Health Reports, 
December 2, 1938) to be used either as a 
precipitin or intradermal test is offered in 
order that more reliable results may be ob- 
tained. 

Antigen prepared by this method involves 
the isolation of trichina larvae-drying and ex- 
traction with neutral salt solution — without 
the use of chemical preservatives — has 
marked specificity and excellent keeping 
qualities. In establishing the diagnosis im- 
plicit reliance should not be placed on a 


single intradermal or precipitin test but due 
care exercised in interpreting the clinical 
symptoms and differential blood picture. 

The distribution of this disease correlates 
closely with the practice of feeding uncooked 
garbage to hogs. Hogs maintained on this 
food show an infection incidence of 5% and 
in the States where this type of feeding is 
carried on — Hew York, California, Massa- 
chusetts and Pennsylvania— lead all others 
in reported cases of the disease. Pork and 
pork products to be safe require cooking un- 
til thoroughly done. This is a very efficient 
measure for protection against the disease. 


12 


The Journal of the Maine Medical Association 


A dv ant ages and Disadvantages of Graduate Nursing in 

Small Hospitals * 

By Mabgaret A. Hebert, R. N., Superintendent, Gardiner General Hospital, 

Gardiner, Maine 


About three years ago the Gardiner Gen- 
eral Hospital discontinued its training school 
and began to employ graduate nurses. The 
most important reason for such a change was 
due to the fact, that since the requirements 
to become and remain an accredited School 
of Nursing had been raised and the stand- 
ards increased more and more each year, it 
proved to us that the small school had no 
longer the right to offer a course to student 
nurses. 

I am not taking the stand, however, that 
small hospitals have not graduated well 
trained, efficient nurses because I feel that 
they have. With the necessary education for 
a background ; a modern equipped hos- 
pital ; with doctors, who try to be 
modern in their treatments and technique ; 
supervisors, who have the proper training 
and interest of the school at heart, ready to 
instruct and supervise treatments of each in- 
dividual nurse, which is possible in a small 
hospital; with affiliations in the services not 
taken or in the minority in their own hos- 
pitals ; I cannot help but feel that that nurse 
is going to find her place in the profession 
and be able to efficiently fill it. However, the 
most difficult requirement for us to fulfill 
seemed to be the affiliation which was neces- 
sary for our students to have. At this parti- 
cular time there seemed to be too many 
nurses. Not too many good nurses, I don’t 
think, but too many needing help and work; 
therefore, some of the hospitals which had, 
up to this time, affiliating courses to offer, 
had either discontinued them or were not 
taking on new affiliates. An affiliation in 
Medical Diseases was next to impossible, con- 
sequently, we were obliged to take an affilia- 
tion not needed in order to meet that require- 
ment set up by the Board of Registration. 
This was not fair to the nurse. After care- 
fully studying the many handicaps which our 
small hospital with a training school must 
meet, it was my honest desire to do the best 
I possibly could for the student, it seemed 
that to give up the school was the only and 
final way to help the nurse. 

Now, when the change was first made, it 
was an easy matter to get nurses, there 


seemed to be plenty, but the last two years 
this does not seem true. I find that the aver- 
age young nurse does not like to live in a 
small town especially after having trained 
or lived in a large city with many advantages 
offered for recreation. They seem much more 
independent as to just what they will do and 
how long they will do it. One ward may have 
nurses all graduated from different hospi- 
tals ; — Just imagine, if you can, what has 
happened to that system or routine that you 
have had for nine or ten years with a train- 
ing school. 

Again there seems to be a constant chang- 
ing; they decide they don’t like, they want 
to try private nursing or they have decided 
to take a special course and you start writing 
and calling all the registers and hospitals 
around. She may come to you and explain 
all this to you and work her notice or she 
may just say good-night, as sweetly as ever 
to you at 7 B. M. but try and find her at 7 
A. M. next morning. This has been to me 
the most astounding and disappointing thing 
in nurses of today. At several different times 
in the past year have I had nurses pack and 
leave overnight with no idea of responsibil- 
ity or thought of the hardships it was work- 
ing on the hospital and no special reason 
known by anyone for them to leave. 

I have also found that a complete graduate 
nursing staff has increased our payroll great- 
ly. We are carrying about sixteen graduates 
with an extra helper at times, while in our 
training school, we had twenty to twenty-two 
pupil nurses with six graduates. I do feel 
that the patients are perhaps a little more 
contented coming in and finding that they 
are to be cared for by experienced nurses. 

My impressions may be very different 
from other superintendents who have made 
the change, due to the fact perhaps that I 
may be a bit old-fashioned in my ideas as to 
what a nurse should be expected to do. How- 
ever, I do hope that in our earnest desire to 
efficiently train our girls today, that we will 
not spend so much time on the Theory of 
Nursing that the practical training still need- 
ed to care for the patient will be forgotten. 


*Read before the 1938 Annual Meeting of the Maine Hospital Association held at Lakewood, August 
31, 1938. 


Volume Thirty, No. I 


Gunshot Wound of the Pregnant Uterus 


13 


Gunshot Wound of the Pregnant Uterus 

REPORT OE A CASE 

By Robert W. Belknap, M. D., Damariscotta, Maine 


While the following case report may not 
be unique, I do not recall ever having seen or 
heard of a parallel instance. It is offered as 
a medical curiosity. 

Mrs. B. D., age 24, IV — gravida, six 
months advanced. Previous pregnancies note- 
worthy only for size of last baby, which 
weighed 12^4 pounds at birth. 

Patient and her husband had been having 
marital difficulties. I had seen her three 
months previously in an hysterical attack. 
She had threatened suicide. She had been 
shooting at rats with a .22 caliber rifle. Her 
husband had hidden the rifle on account of 
her threats. On the afternoon of June twen- 
ty-second she again procured the rifle while 
alone in the house and, as she stated, tried to 
point it at her heart. Apparently because of 
the length of reach necessary to pull the 
trigger, she only succeeded in placing the 
muzzle against the lower abdomen. I saw 
her in about one-half hour and transported 
her in the back seat of an automobile to the 
Lincoln County Memorial Hospital. She was 
immediately placed on the operating table. 
There was considerable pallor, pulse fair 
quality, with the wound of entrance about 
three inches to the left of and below umbili- 
cus. There were powder stains around it but 
very little external haemorrhage. She com- 
plained of severe abdominal pain. 

The wound was swabbed with acriflavine 
and the field surgically prepared. Under 
ether anaesthesia the external wound was 
debrided and the cut extended into a left 
paramedian incision. The peritoneal cavity 
was found filled with a large amount of 
blood and clots. Intestines were well above 
the bullet track and were apparently unin- 
jured. There was a perforation of the uterus 
entering to the left of midline near the lower 
pole and emerging diagonally opposite on the 
right posterior surface at a somewhat higher 
level. Blood poured from both uterine 
wounds. It became a problem what line of 
procedure to adopt. The uterine fundus was 
incised and the foetus delivered. It was dead, 


with a penetrating wound through the left 
chest just below the clavicle. Placenta was 
extracted. Bleeding was profuse from the 
uterine incision and was welling up from 
somewhere behind the uterus. It was decided 
that the uterus was potentially infected and 
that the possibility of further blood loss from 
the wounded uterus and placental site justi- 
fied hysterectomy, therefore a rather hasty 
Porro amputation was done in a very bloody 
field. Peritonization of the stump was rather 
sketchy. With the uterus out of the way, it 
was apparent that the slug had lodged some- 
where in the region of the common iliac 
vessels. There was a retroperitoneal hema- 
toma in this region, and blood welled up 
from the track. This was tamponed for a 
few minutes, and the bleeding lessened. 
Abdomen was closed without drainage. 

The anaesthetist reported her condition 
rather poor. She was kept on the table in 
Trendelenberg position while one liter of 
glucose-saline was administered intravenous- 
ly, with improvement in quality of pulse. 

The next day her pulse was 150, but she 
did not look to be in very poor condition 
except for pallor. Hemoglobin was 50%. She 
was given 900 ml. of whole blood by the 
Drummond apparatus from her husband, 
whose blood was found to cross-match. 

For a week her temperature ran around 
102, pulse 140. There was never evidence of 
peritonitis, and she appeared quite comfort- 
able. On the second day there was gross 
blood in the urine. This cleared up in 
twenty-four hours and recurred in smaller 
amounts for several days after. It was felt 
that the right ureter might have been nicked. 

Temperature and pulse came down slowly. 
There was no sign of wound infection, and 
she went home on the fourteenth day. 

Stereoscopic films showed the slug just 
anterior to the upper part of the right sacro- 
iliac synchondrosis. It would be interesting 
to place it with reference to the ureter with 
a pyelogram. 


The Journal of the Maine Medical Association 


14 


The President’s Page 


To the Members of the Maine Medical Association : 

When this Journal has been released from the press, the Yuletide 
Season will have passed, but due to the fact that I am writing this page 
one week before Christmas, I wish to extend to each member of the Maine 
Medical Association, my best wishes for a Merry Christmas and a Happy 
New Year. 

This is the season of the year when all people should be at peace. 
Serious matters should not disturb our tranquillity ; men’s passions should 
not be in conflict with one another, and as far as humanly possible we 
should avoid the cares and anxieties which interrupt the calm of our daily 
lives. In fact there is no other message that expresses my thoughts so 
clearly as the one taken from the book of St. Luke: “Glory to God in the 
highest, and on earth peace, good will toward men.” 

I am not a student of theology but with the present day crisis of greed, 
selfishness and ambition predominating those characteristics of generosity, 
unselfishness and humility, one cannot help but wonder if this subject has 
not been sadly neglected. 

We are entering into a new calendar year in the history of our State 
Society. As it appears now we may be called upon by our government to 
perform many unpleasant duties. If so, let us face the situation as it may 
be and never for one moment forget that our Society is founded upon the 
very highest principles and composed of a selective group of men whose 
esteemable traits stand second to none. 

Willard H. Bunker, M. D., 

President Maine Medical Association. 


Volume Thirty , No. I 


Editorial 


15 


Editorial 


The Human Side of Medicine 

The experienced physician knows full well 
that patients cannot be grouped and treated 
similar to rabbits, white mice or guinea pigs 
in a cage; that is, successfully. Patients in 
the medium and high income groups enjoy 
and profit from the personal and intimate re- 
lationship between themselves and their at- 
tending physician. The nearer this ideal can 
be approached in the low income or indigent 
groups the better the end results for nothing 
tends more towards recovery than the knowl- 
edge that the attending physician regards one 
as his personal patient and problem. This 
fact is one of the important reasons why com- 
pulsory insurance in this group far from of- 
fers a solution of the economic question now 
engaging the attention of medicine and allied 
workers. 

The proposals of any department of the 
central government of the United States to 
impose such a measure, would, if carried into 
effect, result in the organization of physicians 
into gangs dictated to and ruled bv a political 
bureaucracy with complete destruction of 
professional status and the confidential re- 
lationship between physician and patient. 
One is also hardly off the track when it is 
realized that once such a segment of the pub- 
lic becomes massed under such control that 
political preferences might dictate to no small 
extent the physicians designated to serve un- 
der such a system. A doctor working under 
such conditions would retain a professional 
status in name only. It would be a job, noth- 
ing more and nothing less, and it should be 
remembered that the “patients” would be- 
long to the insuring power or bureau ; not to 
the doctor. He would continue to hold his 
job just so long as he remained in the graces 
of the central authority and agreed to the 
conditions that it would impose and insist 
upon. The assurance of a certain income, 
under such conditions, might appeal to some 
and as far as was possible most men would 
give honest and competent service but at any 
time any or all of the patients could be re- 
moved from a given doctor’s care or he dis- 
missed entirely. 


Before committing the people of this coun- 
try to a repetition of the blunders and condi- 
tions that obtain in some countries it would 
be well for those who consider such a move, 
in whole or part, to acquaint themselves with 
the facts that show that we are living in a 
period of remarkable achievements in public 
welfare. 

Just off the press in a book entitled, “Med- 
icine in Modern Society” we learn that the 
author, Dr. David Biesman, “is critical of 
the association (The A. M. A.) for its stand 
on the relationship between society and the 
medical profession.” What the stand is 
that invites such censure we do not know 
and while we are in accord with the state- 
ment that medical service is as vital to the 
public concern as fire and police protection it 
might well be said that this idea was suggest- 
ed a great many years ago by Dr. W. J. 
Mayo. In fact it was our privilege to hear 
his remarks on the subject and also his in- 
quiry as to why the profession of medicine 
should assume its far, far from proportionate 
share of help to the needy. 


Attention 

Member's and County Secretaries 

Again it is called to the attention of mem- 
bers and County Secretaries that the Jour- 
nal is anxious to receive and publish inter- 
esting case reports and clinical suggestions. 
Those who have the privilege of reading the 
New England Journal of Medicine must be 
impressed with the value and clinical interest 
of the case reports published weekly. Many 
of them show, despite the diagnostic acumen 
of the attending physicians and the most 
careful laboratory procedures, “things are 
not always what they seem.” Members re- 
porting their cases direct to the office of the 
Journal in Portland or any member of the 
Board can be assured that they will be most 
welcome. 


1 6 


The Journal of the Maine Medical Association 


Graduate Fellowships in Obstetrics and Gynecology 

Bingham Associates Fund 

The Bingham Associates Fund, by offering Fellowships, is affording practising physicians of Maine 
the opportunity to pursue a course of graduate study in the field of Obstetrics and Gynecology in Boston. 
This work will be conducted under the control of the Faculty of Tufts College Medical School. The facili- 
ties of the New England Medical Center, the Joseph H. Pratt Diagnostic Hospital, The Boston Dispen- 
sary and the Evangeline Booth Maternity Hospital will be utilized. 

The Booth Hospital, with about five hundred deliveries a year, is under the control of the Professor 
of Obstetrics of Tufts College Medical School. All the clinical teaching material at this institution has be- 
come available for the benefit of these Fellows. Here, by observation and actual personal delivery of 
patients, the most modern methods and the most rigid technique of good hospital obstetric practice will 
be demonstrated and used. Much time will be devoted to prenatal clinic examinations and care, and also 
to ward rounds for post-partum instruction at the bedside. 

This emphasis upon actual experience in the delivery room makes it impossible to maintain any 
fixed schedule for didactic instruction. As far as possible, however, the course will follow this outline: 


Mornings 

Eight hours, ward rounds at Booth Hospital. Bed- 
side study of post-partum patients and also of 
prenatal complications requiring hospitalization. 

Dr. Joseph T. Smith and Assistants. 

Four hours, Booth Hospital. Pediatrics; care of 
the new-born. 

Dr. Elmer W. Barron. 

One hour, Urological Clinic, Boston Dispensary. 
Special atention to Cystitis and Pyelitis in 
pregnancy. 

Dr. Boris E. Greenberg. 

Four hours, Gynecological Clinic, Boston Dispen- 
sary. Case work in office gynecological diagno- 
sis and treatment. 

Four hours, Prenatal Clinic, Booth Hospital. His- 
tory taking, first examinations, follow-up care, 
treatment of the minor discomforts and compli- 
cations of pregnancy. 


Afternoons 

Twelve hours, Obstetrical and Gynecological theory 
taught through case histories chosen to illus- 
trate major Obstetrical and Gynecological prob- 
lems. Special attention will be given to the 
study of abnormal pelves and their relation to 
complications of labor. Discussion by the Fel- 
lows. 

One hour, gross and microscopic Pathology. Tufts 
College Medical School. 

Two hours, laboratory, tests and procedures im- 
portant in Obstetrics and Gynecology. What the 
doctor should do himself; what he should have 
done; when and why. 

Four hours, manikin drill. The use of forceps, 
breech extractions, versions. 

One hour or more, observing operations, making 
ward rounds, or attending lectures on Gyneco- 
logical topics. 

Dr. L. E. Phaneuf. 

Four hours per month, the use of radium in 
Gynecology. 

Four hours per month, the use of X-rays in Ob- 
stetrics. The diagnosis of position, multiple 
pregnancies, etc., by radiation. X-ray pelvi- 
metry. 


These Fellowships are for one month each and are available to graduates of regular medical schools. 
Each one-month Fellowship carries an honorarium of $250.00. Rooms and meals are available for Fellows, 
at reduced rates, in the Medical Center. 


Any doctor wishing to secure such a Fellowship is invited to write to 

Samuel Proger, M. D., 25 Bennet Street, Boston, Massachusetts, 
Frederick R. Carter, M. D., 22 Arsenal Street, Portland, Maine, or 
Frederick T. Hill, M. D., The Professional Building, Waterville, Maine. 


Volume Thirty ; No. I 


County News and Notes 


17 


County News and Notes 


A ndroscoggin 

The regular meeting of the Androscoggin Coun- 
ty Medical Society was held December 15, 1938, 
following a banquet at the DeWitt Hotel. 

Minutes of the last meeting were read. Dr. 
Sweatt read a letter from the secretary of the 
Maine Hospital Association confirming the passage 
of a resolution concerning hospital insurance 
plans. Voted that it be put into the records to con- 
form with the minutes of the last meeting. 

A report from the special committee concerning 
present hospital insurance plans was then read. 
Following discussion upon the subject it was voted 
to adopt the resolution as submitted, namely, that 
we should not endorse any particular plan for 
reasons as set forth by the committee. 

The scientific portion of the meeting was de- 
voted towards a general recognition of the past 
presidents of this society. Dr. Sweatt introduced 
Dr. W. H. Bunker, president of the Maine Medical 
Association, as the guest speaker for the evening, 
who delivered an able and appropriate address for 
the occasion. It carried considerable of inspiration 
and thought to the members in the continuance of 
the spirit of the organization. Dr. George L. Pratt, 
our President-elect, was also present and extended 
his greetings for the occasion. 

Meeting was adjourned at 10.05. 

Respectfully submitted, 

A. E. Peters, M. D., Secretary. 


Cumberland 

George A. Tibbetts, of Portland, was elected 
President of the Cumberland County Medical 
Society at its annual meeting held at the Eastland 
Hotel, Portland, Maine, December 9, 1938. 

Other officers elected were: 

Vice-President, E. H. Drake, Portland. 

Secretary-Treasurer, Harold V. Bickmore, 
Portland. 

Councilor for three years, Henry M. Swift, 
Portland. 

Committee on Legislation, Charles B. Syl- 
vester, Portland. 

Committee on Public Relations, Donald H. 
Daniels, Philip H. McCrum and Richard 
S. Hawkes. 

Delegates to the Maine Medical Association 
1939 Annual Session: L. A. Brown, W. D. 
Anderson and J. C. Oram. 

Alternates: F. A. Smith, Ralph A. Heifetz 

and D. H. Daniels. 

Maxwell E. Macdonald, M. D„ an assistant pro- 
fessor at Tufts, was the speaker of the evening. 
His subject was Emotions and Bodily Changes. 

A Clinic was held at the Maine General Hos- 
pital, preceding the evening meeting, at which the 
following program was presented: 

Sarcoid Dr. Jack Spencer 

Radical Operation for Carcinoma of Scalp 

Dr. E. S. Lothrop 
Dr. R. H. Huntress 


Vitamin Deficiency Dr. T. A. Foster 

Visualization of Liver and Spleen with 

Thorium Dioxide Dr. E. H. Drake 

A Case for Diagnosis 

Drs. Smith, Cutler and Blaisdell 

Pyelogram in a 12-Month-Old Child 

Dr. H. L. Curtis 

Harold V. Bickmore, M. D., 

Secretary. 


Portland Medical Club 

The annual dinner meeting was held at the Co- 
lumbia Hotel, Tuesday evening, December 6th, at 
6.30 P. M. Sixty-one members and three guests 
were present. 

Dr. Leon Babalian, Dr. C. J. Hogan, and Dr. R, 
T. Phillips were elected members of the Club. 

Resolutions on the death of Dr. Willis B. Moul- 
ton were adopted by the Club. 

Officers for the year 1938-1939 were elected as 
follows: — 

President, Dr. Eugene E. O’Donnell. 

First Vice-President, Dr. Theodore Stevens. 

Second Vice-President, Dr. Donald H. Daniels. 

Secretary-Treasurer, Dr. Alice Whittier. 

Board of Censors, Dr. Harold J. Everett, Dr. 
Oscar R. Johnson, Dr. Richard S. Hawkes. 

The annual oration was delivered by Dr. E. W. 
Gehring. His subject was “The Interrelation Be- 
tween Medicine and General Economics.” This 
was a very carefully prepared paper and brought 
out in a clear manner the general economic prob- 
lems and showed how closely allied to these are 
the problems of medical economics and how the 
latter cannot be solved unless those of general eco- 
nomics are also solved. 

Alice Whittier, Secretary. 


Chester F. Hogan, M. D., announces the open- 
ing of an office at 131 State Street, Portland, 
Maine, for the practice of Otolaryngology. Dr. 
Hogan was formerly a resident Otolaryngologist 
at St. Luke’s Hospital, New York City. 


Kennebec 

The annual meeting of the Kennebec County 
Medical Association was held at the Augusta State 
Hospital, Thursday, December 15, 1938. 

Clinical Program: 5 P. M. 

Presentation of cases by members of the staff. 

Dinner 6.30 P. M. 

Followed by business meeting and scientific 
Session. Minutes of the last meeting were read 
and approved. 

The reports of the secretary and treasurer for 
1938 were read and accepted. 

The following members were appointed by the 
Chair to nominate the officers for the ensuing 


Renal Tuberculosis 


18 


The Journal of the Maine Medical Association 


year: Dr. G. W. Alexander, Gardiner; Dr. G. A. 

Coombs, Augusta; Dr. J. G. Towne, Waterville. 

They reported as follows: 

President: Leon D. Herring, M. D., Winthrop. 

Vice-President: Blynn O. Goodrich, M. D., 

Waterville. 

Secretary and Treasurer: Frederick R. Carter, 

M. D., Augusta. 

Councilor for three years: Thomas F. Fay, M. 
D., Augusta. 

Delegates to the Maine Medical Association: 
Samuel H. Kagan, M. D., Augusta; Charles E. 
Towne, M. D., Waterville. 

Alternate: Ivan E. McLaughlin, M. D., Gardi- 

ner. 

It was moved and seconded that the by-laws be 
suspended and the Secretary cast one vote for the 
officers for the ensuing year which was done. 

The speaker of the evening was A. Warren 
Stearns, M. D., Dean, Tufts College Medical 
School, Boston, Mass., who spoke on Medico-Legal 
Problems, discussing the responsibility of physi- 
cians in criminal cases, tort cases, will cases and 
brain and nerve injuries. Dr. Stearns is an au- 
thority on this subject, a fascinating and brilliant 
speaker who drew largely from his experience of 
court and private cases, having been Commission- 
er of Correction and Prisons for four years, mak- 
ing the subject vital and homely. 

In cases involving mental clearness, Dr. Stearns 
stressed the importance of the physician knowing 
the general social conditions and situations before 
deciding doubtful viewpoints. Discussing will 
cases and contests Dr. Stearns stated “The Doctor 
has an obligation, not that of a lawyer, detective 


or mystery fiction writer, but to do his work ef- 
fectively and honestly. 

“The doctor should make an attempt to learn a 
trustworthy appraisal of the real condition of af- 
fairs. The doctor’s job is to do medical work, to 
analyze data properly in order that he may give 
a real opinion.” 

Dr. Stearns differentiated medical diagnosis 
from legal diagnosis. “Skull injuries may result 
in — (1) cerebral edema, (2) hemorrhage, (3) cere- 
bral laceration. A skull fracture does not neces- 
sarily result in brain damage.” The doctor stressed 
the fact that in traumatic neurosis the symptoms 
may have existed before the accident; that it was 
a matter of good faith; and that often there was 
no way of disproving symptoms claimed. 

There were 59 members and guests present. 

Respectfully submitted, 

Frederick R. Carter, M. D., 

Secretary. 


New Members 

Androscoggin 

James A. Sansoucy, M. D., Lewiston. 

Cumberland 

Carl C. Corson . M. D., Portland. 
Robert T. Phillips , M. D., Portland. 
E. Allan McLean, M. D., Portland. 

Hancock 

James H. Crowe, M. D., Ellsworth. 


You Haven’t Seen Us Here Before ! 


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Volume Thirty , No. I 


Necrology 


1 9 


Coming Meetings * 

Waldo 

Waldo County Medical Society, Raymond L. Tor- 
rey, Searsport, Secretary. 

The annual meeting of the Waldo County 
Medical Society will be held at the Windsor 
Hotel, Belfast, on Thursday evening, January 
26, 1939. Dinner at 6.30. C. B. Popplestone, 
M. D., of Rockland, will present a paper on 
Electrocardiography . 

* For more detailed information regarding coming 
county meetings, write to the County Secretary. 


State of Maine Board of Registration 
of Medicine 

Adam P. Leighton, M. D., Secretary. 
Physicians licensed to practice medicine and 
surgery in Maine on November 9, 1938: 

Henry Simpson Hebb, M. D., Bridgton, Maine. 
Thomas Barr Hoxie, M. D., Belfast, Maine. 
Theodore James Hughes, M. D., Portland, Maine. 
Paul Adams Jones, M. D., Union, Maine. 
Joseph Percy Seltzer, M. D., Fairfield, Maine. 

Through Reciprocity. 

Harry Brinkman, M. D., Wilton, Maine. 


Albert D. Foster, M. D.. Portland, Maine. 
Emory Allan McLean, M. D., Portland, Maine. 
Willis Bixler Mitchell, M. D., New York City. 
Robert Titus Phillips, M. D., Portland, Maine. 
Jack Spencer, M. D.. Portland, Maine. 


Annual Roster 

It is usual at this time to publish the 
roster of the officers aud members of the As- 
sociation. Owing to the fact that our official 
list is not correct until the dues of members 
have been remitted by the County secretaries 
the official roster will appear in the May 
number. Members whose names have not 
been submitted by the County secretaries, as 
in good standing, must be omitted so an early 
publication is made so that no embarrass- 
ments will follow. At no time in the history 
of organized medicine has it been more im- 
portant that members retain their standing- 
in State and County Associations. 


Necrology 


Ralph D. Simons, M. D., 

1877-1938 

On Sunday, December 25, 1938, Dr. Simons died 
at. the Gardiner General Hospital, Gardiner, 
Maine, following a brief illness. He underwent an 
operation on December 14th and another on 
December 20th. 

He was born at Starks, Maine, January 31, 1877, 
the son of the late Rev. Elwin Willis and Louise 
K. (Duley) Simons. He was educated at Madison 
High School and was graduated from Bowdoin 
Medical College in 1898. He also studied at the 
Mayo Foundation. 

Dr. Simons began his practice in Kingfield and 
came to Gardiner in 1902. He was active in both 
the medical and surgical fields and was a member 
of the surgical staff at the Gardiner General Hos- 
pital, an institution in w r hich he has been active 
since its inception. 

He was a past president of the Kennebec County 
Medical Association, and a member of the Maine 
Medical Association and the American Medical 
Association. He was for several years president of 
the staff of the Gardiner General Hospital. 


Dr. Simons w r as for many years school physician 
in Gardiner and annually made the rounds of 
Gardiner schools to examine the pupils. He was 
a first lieutenant in the U. S. Army Medical 
Reserve Corps. 

In 1918 he was elected on the Republican ticket 
to the Maine House of Representatives from 
Gardiner, and in 1929 he was appointed to the 
State Board of Registration for Medicine by 
Governor William T. Gardiner. 

His first wife, Alice S. Hunnewell, whom he 
married in Madison, died in 1912, and in 1914 he 
married the former Florence T. Hildreth of 
Gardiner. 

Always active in the social life of Gardiner, he 
was a member of the local Masonic bodies and of 
Kora Temple, A. A. N. M. S., of Lewiston. He had 
long been active in the Universalist church of that 
city. 

Dr. Simons is survived by his wife, two sons, 
Elwin Simons of Whitney Point, N. Y., and Robert 
L. Simons of Chicago; a half brother, Earl Merrill, 
sub-master at Machias Normal School; two step- 
sons, Horace and Charles Hildreth of Portland; 
and several grandchildren. 


20 


The Journal of the Maine Medical Association 


Notices 


The American College of Physicians Will 
Meet in New Orleans, La., 

March 27-31, 1939 

The Twenty-third Annual Session of the Ameri- 
can College of Physicians will he held in New 
Orleans, with general headquarters at the Munici- 
pal Auditorium, March 27-31, 1939. 

Dr. William J. Kerr of San Francisco is Presi- 
dent of the College and will have charge of the 
program of general scientific sessions. Dr. John 
H. Musser of New Orleans has been appointed 
General Chairman of the Session, and will be in 
charge of the program of clinics and demonstra- 
tions in the hospitals and medical schools and of 
the program of round table discussions to be con- 
ducted at the headquarters. 


Fourth Annual Postgraduate Institute 

The Philadelphia County Medical Society de- 
sires to announce formally, the completion of its 
scientific program for the Fourth Annual Post- 
graduate Institute to be held in the Bellevue- 
Stratford Hotel, Philadelphia, during the week 
beginning March 13, 1939. The subjects to be con- 
sidered are those embraced by the terms “Blood 
Dyscrasias” and “Metabolic Disorders.” These 
will be further subdivided for convenience in in- 
struction into eighty-six clinical lectures, with 
open forum discussion for each topic, delivered by 
as many individual specialists of national distinc- 
tion. 

The Postgraduate Institute aims to fill this need 
and the participants may be assured that they will 


unquestionably profit by the program to be pre- 
sented. 

Address all inquiries to The Philadelphia County 
Medical Society, Twenty-first and Spruce Streets, 
Philadelphia. 

The Committee. 


Mississippi Valley Medical Society 1939 
Essay Award 

The Mississippi Valley Medical Society offers 
a cash prize of $100.00, a gold medal and a certifi- 
cate of award for the best unpublished essay on a 
subject of interest and practical value to the 
general practitioner of medicine. Entrants must 
be members of the American Medical Association. 
The winner will be invited to present his contribu- 
tion before the next annual meeting of the Missis- 
sippi Valley Medical Society at Burlington, Iowa, 
September 27, 28, 29, 1939, the Society reserving 
the exclusive right to first publish the essay in its 
official publication — the Mississippi Valley Medi- 
cal Journal (Incorporating the Radiologic Re- 
view). All contributions MUST NOT exceed 5,000 
words, be typewritten in English in manuscript 
form, submitted in five copies, and must be re- 
ceived NOT later than May 1, 1939. Further de- 
tails may be secured from Harold Swanberg, M. 
D., Secretary, Mississippi Valley Medical Society, 
209-224 W. C. U. Building, Quincy, 111. The 1938 
winning essay, as well as several other essays 
which received meritorious consideration in the 
1938 Essay Contest, appears in the Jan., 1939, is- 
sue of the Mississippi Valley Medical Journal 
(Quincy, 111.). 




Book Review 


“ Interne’s Handbook ” 

By Members of the Faculty of the College of 
Medicine Syracuse University, under the direction 
of M. S. Dooley, A. B., M. D., Chairman Publica- 
tion Committee. 

Published by J. B. Lippincott Company, Phila- 
delphia, London, Montreal, 1938. Price, $3.00. 

The Second Edition of this pocket-sized Interne’s 
Handbook has been considerably enlarged. A num- 
ber of entirely new sections have been introduced. 
The information presented is of such a nature that 


every practitioner, most certainly every interne, 
can find ready pointers for emergencies. 

The outline for efficient emergency service could 
perhaps have been still more perfected by stress- 
ing the persistence in the efforts at artificial re- 
spiration after electric shock, drowning, carbon 
monoxide poisoning, etc., for several hours with- 
out any intermission as recently recommended by 
several authorities conversant with this subject. 

Future editions should also contain sections on 
the newer industrial poisons as well as on the 
emergencies related to airplane dispersion of pois- 
onous substances. 



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The Journal 

of the 

Maine Medical Association 


Dolume Thirty Portland, Maine February, 1939 


No. 2 


The Doctor , Family Friend or Public Servant* 

Allan Ckaig, M. D., Medical Director, Eastern Maine General Hospital, Bangor, Maine 


I almost called my subject the Great Med- 
ical Revolution and perhaps I should have 
done so except for the fact that the word 
revolution calls to the minds of most of us 
violent changes frouglit with personal dis- 
aster to many of those individuals or groups 
who are involved in it. The change I have in 
mind is a slower and less violent transforma- 
tion. 

There have been many periods of change 
in the history of our profession. Some of the 
changes have been quite radical and many 
have come about with surprising rapidity 
although most have been slow in their de- 
velopment and more lasting in their effects. 

The great medical change to which I refer 
this evening began about 1880 and has been 
steadily but surely moving forward since that 
time. The entry of medicine as a science 
into a field heretofore occupied by medicine 
as an art has come about in the last fifty 
years. Today medicine is recognized both as 
an art and a science and it is the welding of 
these two in one humanitarian profession 
which in reality constitutes the great medi- 
cal change. Such changes as this in any pro- 
fession may constitute a somewhat treacher- 
ous adventure unless they are controlled by 


those with sufficient vision and strength of 
character to keep them within proper bounds. 
There is at all times a danger that much of 
good in both the art and the science be lost 
in the process of evolution. 

The beloved physician — the old family 
doctor of the past- — has left his mark for all 
time upon the pages of medical history. In 
magazine stories and upon the screen he is 
depicted as being always right in his diag- 
nosis whereas the more modern scientific 
man is depicted as frequently in error. The 
old doctor was extremely poor in scientific 
knowledge but strong in human understand- 
ing. He was mighty awkward with a micro- 
scope or even a blood pressure apparatus, but 
he was extremely adept in handling patients 
and their families and their friends. This 
latter was a real accomplishment. The old 
doctor understood the interdependence of 
mind and of body. He was a psychoanalyst 
before psychoanalysis had become a popular 
term. In this respect he was an artist. 

In the fusing of the art and science of 
medicine have we not lost a considerable por- 
tion of the art ? In our busy search for 
scientific facts which indeed is all important, 
have we not neglected or overlooked the 


* Read before the Eighty-sixth Annual Session of the Maine Medical Association, Bar Harbor, June 
28 , 1938 . 


22 


The Journal of the Maine Medical Association 


human understanding of the old doctor ? 
Each of us can answer this question only by 
applying it to himself personally and by au 
analysis of his own relationships day by day 
in his practice. As through the years medi- 
cine has become more and more of a science 
— the art of human understanding may have 
almost unconsciously slipped into the dim 
shadows of a historic past, and with this 
evolution public opinion concerning our pro- 
fession has unquestionably changed. In the 
days of the old doctor his word was law in 
the family. His opinion be it right or wrong 
was respected. Note if you will today how 
readily people run from one doctor to an- 
other; how they will even go bargain-hunt- 
ing for an operation. We are led to ask our- 
selves this important question. Do our people 
— the public — of today have full trust and 
confidence in us ? If they have not, wherein 
does the fault lie ? May it not be that in the 
search for scientific truth we have not been 
quite consistent in our approach ? Uncon- 
sciously we are losing the art of medical prac- 
tice which should be developed along with the 
science. The medical student and the interne 
in our medical schools and hospitals as a rule 
meets only the patients in the general wards. 
He seldom learns to consider each patient as 
an individual. He receives little if any train- 
ing which will help him to properly under- 
stand human relations. The average young 
medical man of the present day training, un- 
less he is fortunate enough to be personally 
gifted, goes out into practice with a good 
working knowledge of scientific medicine and 
surgery but extremely weak in the intrica- 
cies of human understanding. He can learn 
to meet people and to understand them only 
through the hard school of personal experi- 
ence. He is awkward in his approach and 
often unintentionally offensive. 

The public relations of a doctor or a hos- 
pital about which we hear so much are but 
the sum of individual relations. A period of 
sickness in the home or in the hospital is a 
red letter period in the patient’s life. He 
will talk about it and write letters about it for 
years to come. The doctor plays the leading 
part in that experience and if he is lacking 
in the art of medical practice, no matter how 
skilled he may be as a scientist he creates a 
certain amount of disfavor towards himself 


and towards the honorable profession which 
he represents. 

Prof. Howard Haggard of Yale in a re- 
cent address before the Yew York Academy 
of Medicine said : “Medical research is one 
thing, medical practice is another. In the 
former field are science, cold facts and cold 
fact-finders; in the latter are warm-blooded 
human beings, pursuing what is primarily an 
art, involving social responsibility and 
human values. There is today a greater need 
than ever for socially-minded, public-guiding 
physicians. The diseases that come to the 
front in the modern medical readjustment 
cannot be cured or prevented by impersonal 
science ; they can be controlled only by the 
close and intelligent cooperation of the indi- 
vidual members of the public with the 
physician.” 

For years the medical profession of this 
country both individually and collectively 
has opposed the socialization of medical prac- 
tice. The greatest opponents to the move for 
state or socialized medicine have not, how- 
ever, been the doctor or organized medicine, 
although their opposition has been loud and 
vigorous. The great restraining force has 
been the desire of the average man and 
woman to choose his or her own doctor. That 
desire of a choice of doctor is born of an in- 
dividual respect for and confidence in some 
particular member of our profession. 

If then by neglecting the art of medicine 
we weaken that tie we unquestionably open 
the way for the advancement of a movement 
which organized medicine cannot forestall. 
When our people cease to look upon the doc- 
tor as a kindly individual, as a friend in 
need, as one who practices the art of medi- 
cine as well as the science, then public opin- 
ion will force upon us a system of state 
medicine. 

Is the doctor of today a family friend or a 
public servant or a combination of the two ? 
In the opinion of most of us undoubtedly the 
latter is the case, but in the future will he 
become only a public servant ? Although the 
medical profession does not wish to see the 
complete socialization of medical practice so 
that the practitioner becomes merely a serv- 
ant of the state, paid by the state, still we 
cannot but realize that some aid either state 
or federal must ultimately be provided to 


Volume Thirty, No. 2 


The Doctor, Family Friend or Public Servant 


23 


lighten the increasing charity load which our 
doctors and hospitals are carrying at the 
present time. 

1ST o profession has through the years car- 
ried such a great and ever increasing charity 
load as the medical profession!. Dr. Irvin 
Abell of Louisville in his recent inaugural 
address as president of the American Medi- 
cal Association at San Francisco said: “The 
country’s 130,000 regular physicians are do- 
nating probably one million dollars’ worth of 
services daily to indigent and low-income 
patients, a contribution not equalled or ex- 
ceeded by any agency other than the Federal 
Government.” 

Again and again this problem of caring 
for the indigent and low-moneyed class of 
sick and injured presents itself. Again and 
again an unyielding attitude on the part of 
organized medicine has prevented any com- 
promise or final solution. Developments 
within the last year or so, however, indicate 
an awakening of sound medical thought 
which is most encouraging. 

The services of the physician have a real 
monetary value. In this state and many 
others there is a decidedly uneven distribu- 
tion of charity service in the medical and 
hospital fields. In other words a few of the 
larger hospitals and their medical staffs are 
having a large part of the charity work 
placed upon them. A large percentage of the 
town authorities believe that the hospitals 
in the larger centers are state supported in- 
stitutions to which they may send all their 
indigent or reputed indigent sick. As to who 
pays for the medical treatment and the 
surgical operations, they never seem to con- 
sider that factor worth a thought. There is 
great need here in Maine for a program of 
public education to stamp out many of the 
false ideas concerning medical and hospital 
care. 

During the past five years many false im- 
pressions have taken deep root particularly 
among certain classes of our people. The old 
spirit of rugged individualism and pride in 
personal independence seems to he smothered 
by the doctrines of brain .trusters, adven- 
turers in social economics who have no real 
idea just where they are going or what they 
are seeking. The effect upon the popular 
mind is a serious one. The individual who 
would shirk all responsibility and who de- 
sires to live his life as a part of a great na- 


tional machine is becoming more and more 
in evidence. That society owes them a living 
no matter what their personal economic value 
may be has become the belief and doctrine of 
numbers of our people. That belief has been 
fostered, fertilized in its growth, and util- 
ized for political purposes. You and I are 
aware of this trend no matter what our po- 
litical leanings may be. It is only fair to 
consider that in the case of injury or illness 
to this particular class which I have just 
mentioned, they will expect the state to ex- 
tend its responsibilities for their care or in 
the event of the state not accepting such re- 
sponsibility, it will fall upon the already 
overburdened shoulders of the individual 
medical practitioner. Is he and are the pri- 
vately endowed hospitals, most of which are 
already operating at a large deficit, to be left 
holding the bag? 

In conclusion the following facts are in 
evidence : 

1. The physician of today is and must 
continue to be both a family friend and a 
public servant. 

2. A more compromising and less unyield- 
ing attitude toward social problems and state 
and federal relationships must be assumed by 
organized medicine. 

3. We are in great need in this state of a 
vigorous campaign of education along the 
lines of medical and hospital relationships. 

This important statement should be driven 
home. The general hospitals of the state are 
not state supported institutions and the 
physicians who attend the ward patients in 
these hospitals are not paid for their services 
bv either the state or the hospital. 

Finally, in their private offices and in our 
hospital wards the members of the medical 
profession are making a colossal contribution 
of professional services for which they re- 
ceive no remuneration. The burden is be- 
coming too great and a definite compromise 
arrangement between the state and the pri- 
vate practitioner would seem to offer the only 
solution to the problem. 

Our doctor of the present day is without 
question partially at least a public servant. 
Our hope is that in the readjustments of the 
times he may be able to hold fast to the art 
of medical practice and remain as ever the 
family friend. 


The Journal of the Maine Medical Association 


2U 


Gastroscopic Observations on Chronic Gastritis 

By Charles W. McClure, M. D., and I. R. Jankelson, M. D. 

(From the Gastrointestinal Clinic of the Boston City Hospital, Boston, Mass.) 


The present communication reports inter- 
pretation of gastroscopic observations made 
on patients suffering with various types of 
gastritis. The latter has admittedly been a 
much abused clinical diagnosis. As an exam- 
ple of this may he cited the custom prevailing 
during the last century of calling all chronic 
or intermittent stomach diseases that could 
not be diagnosed as ulcer or cancer, chronic 
gastritis. Thus, the diagnosis was made very 
frequently and often on insufficient evidence. 
It included a great variety of organic and 
functional disturbances of the stomach as 
well as those of other organs within the ab- 
domen. As our diagnostic acumen improved, 
primarily due to newer methods of examina- 
tion, this diagnosis became disreputable and 
largely abandoned. It is true, that at the 
autopsy table, because of the rapid auto-diges- 
tion of the stomach, evidence of chronic in- 
flammation within the gastric mucosa was 
scanty and often absent. This added to the 
discredit of the diagnosis of chronic gastritis. 

Within this century new evidence was ob- 
tained proving beyond a shadow of doubt that 
chronic inflammatory changes within the 
stomach are frequent. This new evidence was 
obtained first through the fixation of the 
stomach immediately after death as proposed 
by Faber and Lange (1). By pouring down 
through a stomach tube formalin solution 
they succeeded in preventing the auto-diges- 
tion of the stomach and were enabled to 
demonstrate histologically the typical changes 
of chronic inflammation in the gastric mucosa. 
With the increasing frequency of gastric re- 
sections, histologic examinations confirmed 
the presence of chronic gastritis in peptic 
ulcer and gastric carcinoma as formulated by 
Konjetzny (2) and others. The last but not 
least method at our disposal is the gastroscope 
which enables us to study the changes of the 
gastric mucous membrane in vivo. 

As long as the opportunities to see the 
manifestations of chronic gastritis were lim- 
ited to surgically resected material in cases of 


ulcer or cancer of the stomach on the one 
hand and to the comparatively few cases of 
primary gastritis seen through the rigid gas- 
troscope on the other hand, our knowledge of 
this disease was meager and deficient. With 
the introduction of the Wolf -Schindler semi- 
flexible gastroscope and the elimination of 
practically all dangers to this examination, 
many more direct observations of chronic gas- 
tritis, primary as well as secondary in type, 
became possible. Since chronic gastritis per 
se seldom leads to death and does not require 
excision of any part of the stomach, histologic 
studies of this condition are not frequently 
possible. Through the semi-flexible gastro- 
scope as yet biopsy specimen cannot be ob- 
tained. Therefore, the correlation between 
the gross appearance of chronic gastritis in 
vivo and its histologic appearance is still not 
well established. The difficulties of this cor- 
relation are enhanced by the fact that through 
the gastroscope only the mucous membrane 
can be observed, whereas the inflammatory 
changes as seen histologically may be con- 
fined mainly to the other layers of the stomach. 

It seemed natural to attempt to correlate 
the evidence of gastritis as obtained by the 
Roentgen-rays and gastroscopy. Unfortu- 
nately, even with the Berg technique the 
Roentgen-rays can only show the enlarged 
rugae of chronic hypertrophic gastritis. Hot 
infrequently in such cases gastroscopy fails 
to confirm the presence of enlarged, thick- 
ened or irregular rugae as shown in the 
following case : 

Case I—l. D., O. P. D. Ho. 502043, 
female, age 18, was seen first at the gastro- 
intestinal clinic on Hovember 12, 1937, com- 
plaining of epigastric pain of one year’s 
duration. This pain was mild and usually oc- 
curred one-half hour after meals and radiated 
into both upper quadrants of the abdomen. 
There was some belching and nausea. At no 
time was there any vomiting. Bowels were 
regular without laxatives. There was no loss 


Volume Thirty ; No. 2 


Gastroscopic Observations on Chronic Gastritis 


25 


of weight. The physical examination was es- 
sentially negative. Gastric analysis after his- 
tamine showed a free HCL of 20 and a total 
acidity of 37. There was no bile, blood or 
excessive amount of mucus in the gastric 
contents. A gastrointestinal X-ray examina- 
tion revealed enlarged rugae of the stomach, 
interpreted as a hypertrophic gastritis. A 
gastroscopic examination within a few days 
of the X-ray examination revealed an entirely 
normal gastric mucosa without any enlarge- 
ment or thickening of the rugae. 

The classification of such cases presents 
difficulties. The gastroscopist is apt to ignore 
the Roentgenologic evidence, the Roentgenolo- 
gist on the other hand, having a graphic rec- 
ord of his findings, questions the value of the 
gastroscopist’s findings. The clinician, par- 
ticularly one who has experience in and knows 
the limitations of both methods, must be the 
final arbiter in such cases. Aware of the fact 
that the Roentgen-ray cannot show evidence 
of atrophic gastritis and that both atrophic 
and hypertrophic changes are frequently pres- 
ent in the same stomach at the same time, 
one should be inclined to accept the classifica- 
tion of an experienced gastroscopist in prefer- 
ence to that of a Roentgenologist. The fol- 
lowing case is briefly cited to illustrate this 
point : 

Case II— C. P., O. P. D. Xo. 433895, 
male, age 28, was first seen at the gastrointes- 
tinal clinic in May, 1938. He complained of 
pain across the abdomen at the level of the 
umbilicus of approximately 7 weeks’ dura- 
tion. This pain was aggravated by food and 
reached its highest point of severity 2 hours 
after a meal. It was not relieved by alkalies. 
There was no nausea nor vomiting. Bowels 
were regular. The physical examination was 
entirely negative. A gastrointestinal X-ray 
examination revealed no evidence of any 
pathology or dysfunction. A gastroscopic 
examination performed within 10 days of the 
X- ray examination showed marked changes 
in the gastric mucous membrane. The mucosa 
of the antrum was definitely hypertrophied, 
while that of the fundus showed a marked 
diminution of the rugae and visibility of a 
fine network of the submucous blood vessels. 

Because of these reasons we are subscribing 


to the classification of gastritis from the point 
of view of the gastroscopist. Here, again, 
various classifications were offered by Schind- 
ler (3), Moutier (4), Simpson (5) and 
others. Since Schindler’s classification is 
simple and practical, we are accepting it with 
some modifications. Schindler’s classification 
is as follows : superficial, hypertrophic, 

atrophic and post-operative gastritis. It con- 
siders only the gross changes of the mucosa as 
seen through a gastroscope. In our own ex- 
perience, we find that one must bear in mind 
the clinical application as well. We are, 
therefore, presenting the following classifica- 
tion. We feel that gastritis etiologically must 
be divided into primary and secondary. The 
secondary gastritis frequently accompanies 
such intragastric lesions as ulcer, cancer, 
polyposis as well as extra-gastric conditions 
like gall bladder disease, duodenal ulcer, cir- 
rhosis of the liver, decompensated heart disease, 
etc. It is also frequently present in the post- 
operative stomach. Morphologically the sec- 
ondary gastritis may simulate a primary one 
and therefore a differentiation of the two is not 
possible on its appearance but can be made 
only after painstaking study of the host from 
every point of view, including Roentgenologic 
and laboratory observations. In so far as this 
is a sine-qua-none, gastroscopy is only an 
additional though valuable method of obser- 
vation, which does not exclude any of the 
older methods at our disposal. With this 
modification we accept the classification as 
superficial, atrophic and hypertrophic, add- 
ing descriptive adjectives to them as simplex, 
ulcerative or hemorrhagic. We therefore pre- 
sent the following classification : 

Primary Gastritis Secondary Gastritis 
Superficial 
simplex 
hemorrhagic 
ulcerative 
Atrophic 
simplex 
hemorrhagic 
ulcerative 
Hypertrophic 
simplex 
hemorrhagic 
ulcerative 


2 6 


The Journal of the Maine Medical Association 


As mentioned before, mixed forms of gas- 
tritis are common, like superficial and hyper- 
trophic or atrophic and hypertrophic areas in 
the same stomach. Still further complicating 
the classification and its application are the 
edema, spasms and hourglass contractions, 
which may be superimposed upon a gastritis. 

Another problem up to now not sufficiently 
considered in gastroscopic diagnosis are de- 
generative changes which undoubtedly occur 
with advancing years and the frequently seen 
pigment spots which are probably end-results 
of previous disease or degenerative changes. 
One is even inclined to consider some forms 
of atrophic gastritis as degenerative changes 
without any inflammatory reaction, as seen 
for instance in pernicious anemia and avita- 
minosis. 

The correlation of the gastroscopic picture 
and the clinical manifestations also presents 
considerable difficulty. There is no doubt that 
morphologic gastritis may exist in the absence 
of all symptoms. On the other hand, sec- 
ondary gastritis may condition to a consider- 
able degree the symptoms of a primary dis- 
ease, like ulcer, cancer of the stomach or gall 
bladder disease. The question of chronic gas- 
tritis versus gastric neurosis is still not 
solved and in the individual case may present 
many or even unsurmountable difficulties. 
We have repeatedly observed in cases of obvi- 
ously gastric neurosis atrophic changes in the 
gastric mucosa. Whether there is a cause and 
effect or merely coincidence we are not ready 
to say. 

The symptoms of chronic gastritis are well 
known, but are not diagnostic. The usual 
symptoms are epigastric distress or fullness 
more or less related to meals. Belching and 
gas is common. Heartburn occurring soon to 
1 or 2 hours after meals is frequent. Pain is 
not a common symptom but when present 
may simulate that of a peptic ulcer. Nausea 
and anorexia are common. Vomiting occurs 
in the acute exacerbations of this disease. 
Hematemesis and melena occasionally occur, 
and may suggest an ulcer or esophageal varix. 
Coated tongue, brassy taste are frequent. 
Bowel disturbances like flatulence, distention, 
borborygmus, constipation and at times diar- 
rhea are seen in this condition. There may 
be some epigastric tenderness on abdominal 


palpation, but frequently the examination is 
entirely negative. The gastric acidity varies 
from case to case. Hyperacidity, normal 
acidity, hypoacidity and anacidity occur. In 
our own experience we could not establish 
any relationship between the titre of gastric 
acidity on the one hand and specific changes 
in gastric mucous membrane on the other. 
Hypertrophic gastritis as seen by the gast.ro- 
scope occurs in the presence of either hyper 
or hypoacidity, but in our experience not 
with a true achylia. Atrophic gastritis may 
show any secretory change including achylia. 
Superficial gastritis likewise gives no uni- 
form changes in gastric secretion. It is obvi- 
ous that in the mixed forms of gastritis no 
one can foretell the secretory response of the 
stomach to a meal or test meal. 

Since the diagnosis of gastritis can be sus- 
pected only on the symptoms and since the 
physical examination gives negative or incon- 
clusive evidence, a clinical diagnosis of this 
condition cannot be made with any certainty. 
Gastric analysis and Roentgen-ray evidences 
are likewise inconclusive. Therefore, the only 
positive proof of the presence or absence of 
chronic gastritis can be obtained by gastro- 
scopy. However, the morphologic evidence of 
gastritis must be interpreted in the light of 
clinical manifestations and laboratory find- 
ings. Whether it is primary or secondary can 
only be told on the basis of Roentgenologic 
and clinical observations. The proper classi- 
fication of gastritis must be based on the 
gastroscopic evidence. The course of the 
disease can be evaluated by its clinical course 
supported by repeated gastroscopic evidence. 
If one accepts this postulate gastritis is obvi- 
ously one sphere in which gastroscopy is of 
paramount importance in diagnosis as well 
as the evaluation of treatment. The value of 
gastroscopy, however, is not limited to the 
diagnosis of gastritis. Many other intragas- 
tric lesions can be recognized and differen- 
tiated by this procedure. Nevertheless, the 
field of usefulness of gastroscopy is limited 
as compared to that of the gastrointestinal 
Roentgen-ray examination. For that reason 
it does not replace the latter examination. To 
the contrary, we have made for ourselves an 
involiable rule, that every gastroscopy must 
be preceded by a gastrointestinal Roentgen- 


Volume Thirty, No. 2 


Non-Profit Hospital Service Plans 


27 


ray examination. Even in the diagnosis of 
chronic gastritis the evidence obtained by 
both examinations must be correlated, as they 
are complementary to one another. Finally, 
the clinical judgment of the physician is the 
last resort as in cases of neurosis, psycho- 
neurosis or hysteria with some changes in the 
gastric mucosa. 

Conclusions 

Chronic gastritis is a common disease. The 
signs and symptoms of this condition are not 
characteristic. The Roentgen-ravs likewise 
are not diagnostic. Gastroscopy not only al- 
lows a diagnosis of chronic gastritis, but also 
permits a proper classification of it. A classi- 


fication of gastritis based on gastroscopy is 
offered. 

Bibliography 

1. Faber, K. and Lange, G. : Die Pathogenese und 
Aetiologie der chronischen Achylia gastrica. 
Ztschr. f. klin Med.. 66:53, 1908. 

2. Konjetzny, G. E.: Die Entzimdung des Magens 
in Henke-Lubarsch Handbuch der Pathology. 
1928, J. Springer Berlin , IV, Part 2, 768. 

3. Schindler, R.: Die Diagnostische Bedeutung 

der Gastroskopie. Munch. Med Wsch., 69:535, 
1922. 

4. Moutier quoted by R. Schindler, “Gastroscopy.” 
University of Chicago Press, 1937, page 180. 

5. Simpson quoted by R. Schindler, “Gastroscopy.” 
University of Chicago Press, 1937, page 180. 


Non-Profit Hospital Service Plans 

As Presented to the Annual Meeting of the Maine Hospital Association , 

Lakewood , Maine , August 31, 1938 

By Eugene H. Young, Executive Director, Associated Hospital Service of Maine, Portland, 

Maine. 


Mr. President and Members of the Maine 
Hospital Association. Ft gives me great 
pleasure to come here and speak to you brief- 
ly about the Associated Hospital Service of 
Maine, and non-profit plans for hospital care. 

Mr. Cahalane, Executive Director of the 
Boston plan, has already covered much of 
the ground, especially the standards estab- 
lished by the Committee on Hospital Service 
of the American Hospital Association. 

So, I will repeat only where necessary to 
show our effort to incorporate these standards 
in the Maine plan. 

The Associated Hospital Service of Maine 
was incorporated and received its Charter 
from the Attorney-General’s Department last 
May. 

The Board is made up of nine Directors, 
three Hospital Trustees, three Doctors and 
three Business Men representing the general 
public, all serving in that capacity without 
remuneration. 

The initial working capital has been pro- 
vided by individuals interested in making 


hospital care available to people of moderate 
and border-line incomes. 

All of the hospitals in Portland and the 
one in Westbrook have signed contracts 
which will assume the responsibility to pro- 
vide hospital service in accord with our con- 
tract with the subscribers. Our contract also 
provides for service in non-member hospitals 
in the event of accident or emergency illness 
while awav from home. 

The balance of the hospitals in Maine will 
be invited to participate in the plan as soon 
as sufficient outside interest is shown or as 
soon as time will permit us to develop it. 

The annual subscription rates are $10.00 
for an individual, $18.00 for husband and 
wife and $2E00 for the family contract. 

These rates are sufficient to remunerate 
hospitals properly for the service rendered 
to subscribers and necessary administration 
expenses. 

Adequate reserves will be maintained to 
cover the unearned portion of advance pay- 
ments. Any surplus remaining will be built 


28 


The Journal of the Maine Medical Association 


up as an epidemic reserve. Our present ar- 
rangement provides for payment of uniform 
rates to all member hospitals. 

Our plan will in no way interfere with 
existing relationships between Doctors and 
Hospitals or between Doctors and Patients. 

And I would like to say right here, — no 
matter how well perfected any plan of this 
kind may be, to a large degree its success 
will be measured by the amount of coopera- 
tion it receives from the medical profession 
and hospital administrators. 

Promotion and administration of the plan 
will be dignified and consistent with the pro- 
fessional ideals of the hospitals. 

Here is the first question which one might 
easily ask, — Is there a need for non-profit 
plans ? “Let’s take a look at the record” and 
here is what we would find. 

Even in that famous and supposedly pros- 
perous year — 1929 — that the first three- 
cents-a-day plan was started, over two 
million of the seven million citizens who re- 
quired hospital care received it free of charge 
from State hospitals, and another group of 
over a million were cared for by privately 
endowed hospitals. Those people were not 
down and out. They were not unemployed. 
They were able to buy food, clothing, shelter 
and other ordinary things out of their sala- 
ries and wages. These things cost about the 
same from month to month and people could 
budget for them. But you cannot budget for 
appendicitis or a broken leg, and even in 
1929 millions of people simply could not 
afford to pay relatively large sums for hos- 
pital care and so they were hospitalized at 
the expense of the State or in hospitals kept 
going by private donations. This does not 
mean that these people were parasites. By 
and large they were not looking for some- 
thing for nothing. Neither were they so 
poor that they could not pay something. The 
point is, that they could not lay out a lot of 
money at one time and there was no provi- 
sion or method by which they could buy hos- 
pital care on an easy payment plan. 

Today about fifty or sixty communities 
either have full-fledged non-profit plans in 
operation or are developing them, and it has 
been estimated that nearly two million per- 
sons are enrolled. 

No two plans are alike in detail nor do 


they use the same corporate names but they 
are alike in principle, namely, groups of in- 
dividuals make equal and regular payments 
to a common fund (the association) which 
is used for the purchase of hospital care for 
themselves or their dependents. 

The systematic payments made by sub- 
scribers in non-profit plans tend to reduce the 
risk and load which has been carried by the 
hospitals in the past. 

The Association also enters into contracts 
with hospitals which provide certain service 
to these subscribers that rely upon the hos- 
pital service plan for payments. 

The hospitals of this State are as should 
be, cooperative rather than competitive insti- 
tutions. For this reason the American Hos- 
pital Association does not recommend the es- 
tablishment of more than one non-profit plan 
in each community. Too much emphasis 
cannot be placed upon the opportunity for 
all hospitals of standing to participate in the 
same non-profit plan. 

The subscriber to the Maine plan will re- 
ceive for his three-cents-a-day or about ten 
dollars a year, three weeks of hospitalization 
in a semi-private room. This period may be 
used up, on one or more visits. Of course the 
sick subscriber gets more than a bed because 
they need other things. The benefits included 
under our plan cover the treatment and care 
of all illness and injuries regularly accepted 
for treatment by the member hospital select- 
ed by the subscriber, including X-ray, lab- 
oratory examinations, anesthesia, free use of 
the operating rooms and hospital maternity 
care. A large number of subscribers or their 
dependents are expectant mothers and under 
the Maine plan they are given free use of the 
delivery room, board, laboratory examina- 
tions, medicines, dressings and nursery care 
of the newborn child. The services of the 
Doctor are of course not included because 
the plan provides only for hospital care and 
not for medical or surgical services, and no 
provision is made for special private nursing. 

There are family, as well as individual 
memberships available to subscribers. A fam- 
ily arrangement includes husband, wife and 
all unmarried children under age nineteen. 
In the Maine plan a family membership is 
only $24.00 a year or $2.00 a month no mat- 
ter how many children are included. 


Volume Thirty, No. 2 


Case History 


29 


One great advantage of all the plans, how- 
ever much thev differ in detail throughout 
the country, is that they are free of red tape. 
If a subscriber’s doctor sends him to a mem- 
ber hospital, the patient simply presents his 
identification card and he is then treated 
during his entire stay as though he had paid 
all his hospital bills in advance. 

Can you hospital superintendents and 
trustees concerned with balanced budgets 
imagine ward patients being admitted to 
semi-private rooms with all the charges paid 
in advance ? 

That is what it really amounts to when a 
subscriber enrolls in a non-profit plan and 
pays his premium in advance or agrees to 


make installment payments through his place 
of employment, for an annual hospital serv- 
ice contract. The association merely acts as 
the clearing-house and custodian of the funds 
until hospital care is needed. 

The three-cents-a-day plan represents a 
common sense solution to a problem that con- 
fronts millions of- American families every 
year, and I am glad that it is being solved by 
the people themselves, by enrollment in these 
non-profit plans. This is just another social 
invention which Americans have made vol- 
untarily. 

The plan exemplifies the American ideal 
of individual initiative and social responsi- 
bility without political interference. 


Case History 


Mrs. L. B., Maine General Hospital, No. 
2215. Admitted November 17, 1938, com- 
plaining of difficulty in respiration of about 
two months’ duration. 

Past History: Essentially negative save 
for usual childhood exanthema. No opera- 
tions. Never been gravid. Menses normal. 
Menopause at 42. G. IT. negative. No noc- 
turia, dysuria or hematuria. No dyspnea or 
orthopnea other than as stated in P. I. 
Patient has been a known diabetic for about 
two years. Has been getting along on a diet 
of her own making, restricting the use of 
sugar only. About two years ago she started 
to lose weight, had a great deal of pruritis 
about the anus and vulva without evidence of 
rash or discoloration. This she states ceased 
on a diet but she has continued to lose weight. 
Original weight 200 pounds. Weight on ad- 
mission 140 pounds. Has had polydipsia and 
polyuria. About two months ago had a severe 
bronchitis with a productive cough which 
lasted some time. A residual, slightly pro- 
ductive cough still persists with bloody ex- 
pectoration. No night sweats but marked 
feeling of weakness. She has been rather 
drowsy the last few days with increasing 
difficulty in breathing. Skin dry. 


Physical Examination: Well developed 

obese adult female lying quietly in bed, 
breathing with some difficulty. Skin and 
sclera clear. Normal female distribution of 
hair. Head, no masses or tenderness. Hair, 
fine, gray. Eyes, pupils round, regular and 
equal. React to light and accommodation. 
No petecliiae. Sclerse clear. Ears, no mas- 
toid tenderness, no discharge. 

Nose : — No discharge. 

Mouth: — Teeth fair, pharynx slightly inject- 
ed. Tongue protrudes in mid line with- 
out tremor, slightly coated. Buccal m.m. 
clear. No petechiae. 

Neck: — Not stiff, Trachea in mid line. Thy- 
roid not palpable. Cervical lymph- 
adenopathy. 

Chest: — Slight splinting of left chest on res- 
piration. Area of increased whispered 
voice and breath sounds in left chest, 
lower and upper lobes posteriorly. Ex- 
pirations slightly prolonged throughout. 

Heart : — No increase in size, sounds good 
quality, regular rate and rhythm, 110, 
no murmurs. B. P. 90 systolic, 64 
diastolic. 

Abdomen : — Soft, symmetrical, 210 tender- 
ness, no masses or viscera palpable. No 
C. V. A. tenderness. 


30 


The Journal of the Maine^Medical Association 


Extremities: — Cold and dry, marked varico- 
sities of both. legs. No evidence of infec- 
tion in extremities. Reflexes equal and 
physiological. 

The temperature was 98° F., pulse 110, and 
respirations 30. 

Urine, on admittance : 

sugar, yellow 
Acet. 3 plus 
Diac. 3 plus 


Blood sugar 330. 
Blood Report: 


Hemoglobin 

88% 

R. B. C. 

5,640,000 

W. B. C. 

9,500 

Neut. 

68% 

Eosin. 

2% 

Baso. 

2% 

Lymph. 

23% 

Mono. 

.7% 

X-Ray of Chest: 



The entire left chest involved with an al- 
most confluent consolidation which extends 
up to the anterior first lobe. Shows a patchy 
increase in density. The right lower lobe is 
clear. Trachea in mid line. 

Patient was put on a diabetic diet and 
given Insulin. The blood dropped to normal 
limits under this regime. Temperature 
swinging from 98° to, on one occasion, as 
high as 101°. Sedimentation rate 0. Re- 
peated sputa examinations revealed the acid 
fast bacillus. Patient was taught to give In- 
sulin to herself and because the diabetes was 
under control it was deemed advisable for 
her to return home and be admitted to a 
Sanatorium for treatment of pulmonary 
condition. 

Just as the patient was leaving the hos- 
pital she experienced a severe pain in her 
chest, became cyanotic with rapid increase 
in respiration and expired within fifteen 
minutes. 

On the day of discharge patient had com- 
plained of pain in left leg to her family but 
not to the staff. 

Clinical Diagnosis 
Pulmonary Embolus 
Diabetes mellitus 
Pulmonary tuberculosis 
Varicose Veins 


Pathological Report 

Description: Body is that of a well devel- 
oped and nourished female, 162 cm. in 
length. Hair gray. Pupils equal, 5mm. 
Marked varicosities in. both lower ex- 
tremities. On making incision through 
abdominal wall, a small vessel is found 
in subcutaneous fat which contains a 
thrombus. Veins of both lower legs are 
dilated, tortuous, and solid. 

Lymph nodes: No Gr. 0. E. 

Mediastinum: On opening pulmonary ar- 

tery, ante-mortem thrombi are found in 
right and left arteries. 

Pleural Cavities: Fairly easily broken up 
adhesions over apex of left lung. Many 
firmer adhesions between right lung an- 
teriorly and chest. No fluid. 

Rt. Lung: 250 gms. Evidently contracted; 
rather beefy, and air-containing. On 
palpation, it is full of nodules. On cut 
surface nodules appear as grayish-red 
raised areas of varying sizes, largest 
5 mm. in diameter. In apex of upper 
lobe is a cavity about 1 cm. in diameter, 
containing caseous material. 

Lt. Lung: 800 gms. Upper lobe firm and 
infiltrated with spherical areas of dense 
grayish-red tissue. In general lung is 
mottled with slightly raised grayish 
areas varying from pinhead size to 4-5 
mm. in diameter. The larger areas 
reach a diameter of 7.5 cm. Lower lobe 
of same general character. In mid por- 
tion of lower lobe, and toward root of 
lung, is a very large cavity, bilocular, 
measuring 7x6 cm. in greatest diam- 
eter. The peribronchial nodes are some- 
what enlarged. 

Pericardial Cavity: Small amount of clear 
serous fluid. 

Heart: 250 gms. T. V., 11 cm.; P. V., 6 
cm. ; R. W., 4 mm. ; R. C., 7 cm. ; M. V., 
8 cm. ; A. V., 7 cm. ; L. W., 2 cm. ; 
L. C., 9 cm. 

Heart muscle normal. Thoracic aorta 
smooth. Right ventricle contains clot 
which is well moulded and branched, 
main part measuring 5 cm. in length, 
with the two branches 7 cm. Left des- 
cending coronary patent; slightly thick- 
ened on one periphery. 


Volume Thirty, No. 2 


Case History 


31 


Abdominal Cavity: No fluid, no adhesions. 

Spleen: 275 gins. 15 x 9 x 3 cm. Substance 
soft and follicles very prominent. 

Rt. Kidney: 150 gms. 13 x 6 x 2.5 cm. 
Markings very distinct ; very similar to 
other kidney. 

Lt. Kidney: 175 gms. 12 x 5 x 2.5 cm. 

Markings distinct. 

Adrenals : About same size and appearance ; 
each shows little central cavitation. 

Pancreas : Grossly normal. 

Liver: 2200 gins. 25 x 17 x 11 cm. Consis- 
tency normal ; color dusky. 

Gall Bladder: Contains large oval stone, 2.5 
x 1.5 cm. 

Intestines : N ormal . 

Bladder : Normal. 

Genitalia: Protruding from fundus of 

uterus is a pedunculated nodular fibroid 
tumor 6 cm. in length. Tubes and ova- 
ries present and normal. Uterus normal 
on section, but on anterior aspect is a 
subserous tumor. 

Cranial Cavity : Not opened. 

Anatomical Ddignosis :* 

1. Pulmonary embolism. 

2. Pulmonary tuberculosis, with cavitation 
of left lower lobe and fibrosis of right 
lung. 

3. Cholelithiasis. 

4. Uterine fibroid. 

5. Thrombosed varicose veins in both legs. 
Microscopic Examination : 

Spleen: Near capsule one solitary tu- 
bercle was found, without giant 
cells. 

Lungs : Caseous tuberculosis. 

Liver : Small focal scattered granulo- 
mata, consisting of epithelioid cell 
reaction with lymphocytes ; no 
giant cells. 

Tumor: Fibromyoma of uterus. 
Kidney: Moderate arteriosclerosis with 
some scarring and obliteration of 
occasional glomeruli. 


Pancreas : Appears normal, except for 
small hyalinized areas, the signifi- 
cance of which I do not know. 

Summary : As Anatomical Summary, except 
for solitary tubercles in spleen and liver. 

* Reference: “Thrombosis: A Medical Prob- 

lem” — Mead Burke: Amer. Jour, of Med. Sciences , 
196: 6: pg. 796, Dec., 1938. 

Comment 

(E. R. Blaisdell, M. D.) 

In reviewing this case, it seemed to me 
that the outstanding features were : the co- 
existing diabetes and pulmonary tuberculosis, 
the 0 sedimentation rate in the presence of a 
“destructive” type of tuberculosis, and sud- 
den death from pulmonary emboli in a pa- 
tient who showed at autopsy multiple venous 
thrombi of the legs. 

The presence of tuberculosis and diabetes 
in the same patient is not uncommon and the 
response to treatment is, in most instances, 
usually good. In many clinics, X-ray exami- 
nation of the chest is a routine procedure in 
all diabetics. During the past two years, this 
has been done in the majority of service dia- 
betic patients at the Maine General Hospital. 

I am unable to explain the 0 blood sedi- 
mentation rate. There is no record of the 
test having been repeated in this patient. 
One would naturally expect that rate to be 
increased in the presence of the amount of 
tissue destruction that was found at the post- 
mortem table. Certainly, there should have 
been enough exudative absorption to influ- 
ence the rate. 

The pathological report makes no mention 
of dissection of the lower extremities. How- 
ever, presumably there were also thrombi in 
the deep veins as emboli from superficial 
veins are rare. 

Sudden death from a pulmonary embolus 
is, unfortunately, not infrequent following 
pelvic surgery and hernia operations. Medi- 
cal patients are likewise not immune from 
such a catastrophe. Death does not neces- 
sarily follow a pulmonary embolism, and 
both the roentgenologist and pathologist have 
taught us that unexplained chest pathology 
in both medical and surgical patients is fre- 
quently due to pulmonary infarction. This 
brings to my mind an important question. Is 


32 


The Journal of the Maine Medical Association 


our present custom of keeping medical pa- 
tients who are suffering from chronic disease 
completely at rest a proper procedure ? Sur- 
geons have, for a long time, advised bed exer- 
cises for the postoperative patient, — while 
medical patients, frequently not acutely ill, 
are kept constantly in bed during a long ill- 
ness. Should we be less rigid and, for ex- 


anrple, allow the patient who is satisfactorily 
convalescing from congestive heart failure to 
walk a few steps to the toilet for a daily 
bowel evacuation ? By so doing, it has oc- 
curred to me that we might decrease the in- 
cidence of pulmonary embolism in medical 
patients. 


The T oxemias of Pregnancy and Electrolytes 


A most valuable presentation of this sub- 
ject was made by McPliail of the Great Falls 
Clinic, Montana, before the Section on Gyne- 
cology and Obstetrics, A. M. A., June 15, 
1938. In the past few years remarkable 
clinical studies have developed most impor- 
tant facts regarding water balance, acid-base 
equilibrium, renal function and shifts in 
body water and electrolyte. At our meeting 
at Belgrade we had the opportunity to hear 
Frederick Coller, Professor of Surgery at the 
University of Michigan, present a most in- 


structive and valuable paper on original 
work done on this subject. The paper by 
McPliail deserves to be read and studied by 
all who are actively engaged in obstetric 
work, it appears in full in the Journal of the 
American Medical Association, November 
19, 1938. 

The following summary expresses briefly 
the clinical observations based on two thou- 
sand obstetric cases under the care of the 
author. 


Table 2. — Summary of Maternal and Infant Mortality for Toxemias of Pregnancy in Cases 

in Which the Infant Reached, a Period of Viability 
Nonconvulsive, All Types 


Date 


Antepartum 

Observation 


Oases 

Maternal 
Infants Mortality 

Infant 

Deaths 

and 

Still Births 

Infant 

Mortality, 

Percentage 

1931-1935' 

Yes 




45 

46 

0 

3 

6.5 

1,000 deliveries; 
treatment 

Not 

treated 

until 

toxemia 






conservative 

was 

severe . 



7 

8 

0 

3 

37.5 

1935-1938 
1,000 deliveries; 

’ Yes 




53 

54 

0 

1 

1.8 

treatment, 
forced fluids, 

Not 

treated 

until 

toxemia 






neutral diet 

was 

severe . 



6 

7 

0 

4 

57.0 





Convulsive Type 






'Yes 




2 

2 

0 

0 

0 

1931-1935 • 

Not 

treated 

until 

toxemia 







was 

severe . 



4 

6 

0 

2 

33.3 


f Yes 




0 

0 

0 

0 

0 

1935-1938 ^ 

Not 

treated 

until 

toxemia 







was 

severe . 



0 

0 

0 

0 

0 


Summary 



yieklin 

g an 

alkaline ash leads to retention of 


1. The toxemias of pregnancy occur in 
women with some previous impairment of 
renal function. This impairment leads to a 
gradual retention of urinary waste and 
electrolyte. 

2. Retention of urinary solids leads to 
dehydration of all the cells of the body and 
the fetus. Dehydration alters the function of 
the cells and accounts for metabolic changes 
in the various organs of the body. 

3. Retention of electrolyte is responsible 
for the different types of toxemias. A diet 


alkaline ions and the development of cellular 
dehydration in the presence of edema. A diet 
high in acid ash leads to retention of acid 
ions with general dehydration of all cells. 

4. The toxemias may be prevented by the 
ingestion of large quantities of fluid and a 
neutral diet low in sodium if treated early, 
or they may be controlled at any time if 
treated before severe cellular damage has 
resulted. 


5. The infant mortality for the toxemias 
of pregnancy can be lowered. 


Volume Thirty, No. 2 


The President’s Page 


33 


The President’s Page 


To the Members of the Maine Medical Association : 

Unfortunately, during the last decade there has been a growing ten- 
dency on the part of the members of our profession to forget the honor 
and dignity bestowed upon them when the letters M. D. were affixed to 
their names and through carelessness they have allowed the prefix Dr. to 
take its place. 

Surely they have not forgotten that day in June so many years ago, 
when clothed in flowing gowns, surrounded by friends and relatives, they 
were presented with a sheepskin by one of the members of their faculty 
which signified that they had completed four long years of study devoted 
to the Science of Medicine, and as a result of their diligence and persever- 
ance, had honestly earned the degree of Doctor of Medicine. 

The members of our profession must agree that the prefix Dr. has lost 
its significance and when placed upon the office door, letterhead or prescrip- 
tion pad. affords us no mark of distinction, while the letters M. D. affixed 
to our name place us in an exclusive category indicative of that high type 
of education which is demanded of us before we are entitled to the degree 
of Doctor of Medicine. 

We are the custodians chosen to care for the ills and medical calamities 
confronting the people of our country, and this being true, let us strive at 
least to maintain our dignity to the extent of designating by the letters 
M. D. that we are followers of the medical profession and avoid the prefix 
Dr., which unfortunately does not even imply that we have in any way 
acquainted ourselves with the elementary principles of medicine. 

Willard H. Bunker, M. D., 

President Maine Medical Association. 


The Journal of the Maine Medical Association 


34 

Editorial 


The Woman s Field Army and 
the Cancer Clinics 

At a recent meeting of the advisory board 
of the Woman’s Field Armv of Maine certain 

*J 

definite and important facts were brought out 
which it is desired to place before the medi- 
cal profession of the State. 

When the Woman’s Field Army started its 
work in 1937 the cancer clinics of the State 
were poorly attended and were far from or- 
ganized and staffed on their present basis. 
We were also faced with the fact that some 
patients suitable for X-ray and radium treat- 
ment, some of whom probably could have 
been greatly benefited if not relieved entire- 
ly, could not be so treated since sufficient 
funds were not available. 

As a result of the 1937 spring membership 
drive some $6,000.00 was made available to 
the clinics for diagnosis, X-ray and radium 
treatments for a certain referred group of 
patients. As a direct result of this contribu- 
tion a rapid demand for the service ensued 
so that by the first of September, 1938, all 
funds that had been allocated for this pur- 
pose were entirely used up. 

These facts strongly emphasize two things : 

1. The value of and the direct results ob- 
tained from educational efforts, which 
brought increasingly large numbers of cases 
to the clinics each month and, 

2. The need of more funds to carry on 
the expense of X-ray and radium treatment 
and to improve the quality of the service 
rendered. That it is utterly impossible, also 
unfair, to feel that all indigent cancer pa- 
tients can or should be taken care of through 
funds raised by the Woman’s Field Army 
must be obvious. 

The problem of how to best handle this 
situation has given the State Advisory Board 
no little concern and many long hours of dis- 
cussion have been spent in an endeavor to 
reach a solution which shall bring the great- 
est benefit to the indigent cancer patient and 
yet be fair to the hospitals handling these 
clinics. The Board feels very strongly that 
the rapid growth of the clinics, also the de- 


mand on the part of the public for more 
funds for treatment, has very definitely dem- 
onstrated the value and the need of the clin- 
ics as permanent parts of the State aid to 
the sick. 

The situation in Maine differs from that 
in such States as Massachusetts and others, 
which maintain hospitals for the exclusive 
care of the cancer patient. It must be under- 
stood, however, that with the allotment of an 
increased appropriation of funds for State 
aid to hospitals this coming year, the Legis- 
lature is unwilling and justly so to ear mark 
any part of the appropriation for “cancer 
treatment alone.” 

We can point with justifiable pride to the 
work of the Woman’s Field Army in Maine 
as it is the only army so far in the United 
States to provide both for education and 
treatment of cancer patients. It should be 
understood by everyone that this contribu- 
tion to treatment was an entirely voluntary 
one — there was no legal obligation — and it 
ceased only when — and because — the funds 
raised were inadequate to meet the rising 
demands of the rapidly growing clinics. It 
should also be understood that as funds be- 
come available to the Field Army, over and 
above what is necessary for educational pur- 
poses, they will again be contributed towards 
treatment. 

We believe that, education is of prime im- 
portance. That it has been eminently suc- 
cessful in Maine is evident by the rapidly 
growing number of patients seeking advice 
at the clinics. It is the intention of the 
Woman’s Field Army to carry on a vigorous 
campaign again this coming Spring, both for 
educational purposes and for further funds 
with which to defray the expenses of the in- 
creasing clinic demands. 


Piscataquis Scores Again 

To Piscataquis County Medical Society, 
for the second successive year, goes credit for 
being first to send in to the Maine Medical 
Association office 100% payment of 1939 
dues. Check covering all members was re- 
ceived on January 4, 1939. 


Volume Thirty , No. 2 


Financial Grants for Cancer Research 


35 


Panel Discussion on Pneumonia 


The York County Medical Society, under 
the auspices of the Committee on Graduate 
Education, presented a most valuable and 
interesting panel discussion on pneumonia 
at a meeting held in Scarboro on January 
4th. It would certainly seem that this sort 
of a program, on many subjects, offers a 
great deal in graduate educational efforts. It 
brings to the members the experience of 
those skilled and interested in the different 
topics they have assigned and what is even 
of more importance, invites free discussion 
from the audience. It seems to your Gradu- 
ate Educational Committee that such pro- 
grams surpass in many ways the didactic 
type of paper too frequently presented. Any 
County Society that cares to have this pro- 
gram on pneumonia can ascertain the avail- 
able dates from Dr. Frederick T. Hill, Chair- 
man, Waterville. Every effort will be made 
to provide a time agreeable if the committee 
can have sufficient advance notice. As time 
goes on the committee hopes to have definite 


and stated panel discussions available on 
other important medical and surgical sub- 
jects and it will during the winter months 
gladly provide one on any subject that is 
called for provided it can have sufficient time 
to obtain the personnel required. 

The following physicians comprised the 
panel : 

Chairman: Frederick T. Hill, Waterville. 

History and Examination: T. E. Hardy, 
Waterville. 

Pathology: Julius Gottlieb, Lewiston. 

X-ray Diagnosis : Langdon T. Tliaxter, 
Portland. 

Cardiac Complications : E. H. Drake, 

Portland. 

Surgical Complications : S. A. Cobb, San- 
ford. 

Medical Treatment : E. R. Blaisdell, Port- 
land. 




Financial Grants for Cancer Research 


Financial grants for cancer research in 
designated hospitals and medical colleges was 
considered by the National Advisory Cancer 
Council at its all-day meeting January 3 at 
the National Institute of Health. 

Surgeon General Parran, who is ex-officio 
chairman of the Council, also said the Coun- 
cil will discuss policies regarding the train- 
ing of specialists in various phases of cancer 
work and plans for increasing public knowl- 
edge concerning cancer symptoms and the 
necessity for early treatment. 

Reports will be presented by Dr. Ludvig 
Hektoen, executive director of the National 
Advisory Cancer Council, and Dr. Carl 
Voogtlin, Chief of the National Cancer In- 
stitute. Distribution plans for the $200,000 
shipment of radium which arrived in Wash- 
ington two weeks ago will be included in the 
reports. The 9y 2 grams owned by the insti- 
tute are now being tested at the Bureau of 
Standards. Within the next two months most 


of this radium will be loaned out in small 
quantities to hospitals, cancer clinics and 
medical centers, in acordance with regula- 
tions approved by the Council at its October 
meeting. 

The meeting was the first attended by 
Dr. Mont R. Reid, director of Surgical 
Service, Cincinnati General Hospital and 
Professor of Surgery at the University of 
Cincinnati, and Dr. Janies Murphy, Chief 
of the Cancer Research Division of the 
Rockefeller Institute, New York, who were 
chosen last month as new members of the 
Council for three-year terms. 

Continuing members of the Council who 
were present at the meeting included Presi- 
dent James B. Conant of Harvard Uni- 
versity, who is an authority on chemistry ; 
Dr. Arthur IT. Compton of the University 
of Chicago, a Nobel prize-winner in physics; 
Dr. C. C. Little, Managing Director of the 
American Society for the Control of Cancer ; 


36 


The Journal of the Maine Medical Association 


and Dr. Ludvig Hektoen, of Chicago, former 
director of the John McCormick Institute for 
Infectious Diseases, who is serving as execu- 
tive Director of the National Advisory Can- 
cer Council. 

Dr. Hektoen, as executive director, com- 
mented on the recent grant to Meharry 
Medical College of Nashville, Tennessee, for 
the support of its cancer clinic, and the new 


developments in connection with the cyclo- 
tron, the atom-smashing machine set up in 
the California Institute of Technology. 
He presented the opinions expressed by 
the deans of medical schools and officers of 
the American Board of Surgery and the 
American Board of Radiology, concerning 
the training of cancer specialists. 


County News and Notes 


Androscoggin 

The annual meeting of the Androscoggin County 
Medical Society was held January 19, 1939. 

Minutes of the last meeting were approved as 
read. A preliminary report on the T. B. Associa- 
tion work was given by Dr. Russell. A full report 
on the treasury will be given at the next meeting. 

Report of the Secretary-Treasurer approved as 
read. 

Dr. Dupras raised the question regarding com- 
mercial telephone rates at medical residences. 
Following discussion, a motion was made by him, 
and carried, that a committee comprising the in- 
coming President and Secretary look this up for 
the next meeting. 

The President nominated Drs. Russell, Higgins 
and Fahey as a Nominating Committee for Officers 
for the ensuing year. 

The following officers were elected: 

President, L. P. Gerrish, M. D. 

Vice-President, John C. Cartland, M. D. 

Secretary-Treasurer, Wedgwood P. Webber, M. D. 

3rd Council Member, H. L. Garcelon, M. D. 

Delegates to the Annual Session of the Maine 
Medical Association, D. F. D. Russell, M. D., and 
L. A. Sweatt, M. D. 

Public Relations Committee, S. L. Andrews, M. 
D., R. A. Beliveau, M. D., M. J. Harkins, M. D. 

This was followed by a short discussion by the 
retiring President regarding present-day medical 
relationships and possible tendencies. 

A. E. Peters, M. D., Secretary. 


Hancock 

The annual meeting of the Hancock County 
Medical Society was held on November 30, 1938. 

The following officers were elected to serve dur- 
ing the year 1939: 

President, G. A. Neal, M. D., Southwest Harbor. 
Vice-President, R. B. Coffin, M. D., Southwest 
Harbor. 


Secretary-Treasurer, M. A. Torrey, M. D., Ells- 
worth. 

Delegate to the Annual Session of the Maine 
Medical Association, M. A. Torrey, M. D., Ellsworth. 

Alternate, J. H. Crowe, M. D., Ellsworth. 

Censors: R. W. Wakefield, M. D., Bar Harbor 

(three years); Edward Thegan, M. D., Penobscot 
(two years); Philip Gray, M. D., Brooksville (one 
year). 

G. A. Neal, M. D., Secretary. 


Knox 

The annual business meeting of the Knox County 
Medical Society was held December 27, 1938, at the 
Copper Kettle, Rockland. Doctors Gilmore Soule of 
Rockland and John B. Curtis of Thomaston were 
admitted to membership by approved applications, 
and Dr. Bousfield of North Haven was transferred 
from Hancock County Medical Society. 

The approaching clinic of the Red Cross for 
diphtheria immunization was approved, and the 
doctors’ services volunteered. 

Dr. Appollonio gave a very interesting short talk 
on his trip with MacMillan to Labrador and Green- 
land, reviewing his medical findings. 

Officers elected were; 

President, Howard Apollonio, M. D., Camden. 

Vice-President, Charles B. Popplestone, M. D., 
Rockland. 

Secretary-Treasurer, A. J. Fuller, M. D., Pema- 
quid. i 

Board of Censors, Alvin Foss, M. D., Rockland. 

Delegates to the Annual Session of the Maine 
Medical Association: Howard Apollonio, M. D., 

and A. J. Fuller, M. D. 

Alternates: Gilmore Soule, M. D., and John B. 
Curtis, M. D. 

The next regular meeting is scheduled for Febru- 
ary 14th. 

A. J. Fuller, M. D., Secretary. 


Volume Thirty, No. 2 


County News and Notes 


37 


Penobscot 

The regular monthly meeting of the Penobscot 
County Medical Association was held Tuesday, 
December 20, 1938. Guests of the Association were 
Dr. W. H. Bunker, President of the Maine Medical 
Association, and Dr. Channing Frothingham, Presi- 
dent of the Massachusetts Medical Association. Dr. 
Frothingham conducted a medical clinic at the 
Eastern Maine General Hospital during the after- 
noon. 

Following dinner at the Bangor House at 7 P. M., 
a group of 61 interested physicians listened to the 
speakers of the evening. Dr. Bunker presented 
some of the problems which confront the Maine 
Medical group, and his remarks elicited long and 
lively discussion from the floor. Dr. Frothingham 
chose for his subject “Economic Problerhs in Medi- 
cine,” stressing especially the need for concerted 
and coordinated effort by the medical profession to 
meet the challenge from the laity at the present 
time. Some proper form of insurance was advo- 
cated by the speaker. 

J. Robert Feeley, M. D., Resident Surgeon at the 
Eastern Maine General Hospital, was elected to 
membership. 

Forrest B. Ames, M. D., Secretary. 


Norman W. Loud, M. D., A. B. R. in Diagnostic 
Roentgenology, has recently joined the Staff of the 
Eastern Maine General Hospital as Associate Roent- 
genologist. 


Board of Censors: S. A. Cobb, M. D., Paul Hill, 
Jr., M. D., and E. C. Cook, M. D. 

Delegates to the Annual Session of the Maine 
Medical Association: S. A. Cobb, M. D., and C. W. 
Kinghorn, M. D. 

Alternates: W. H. Kelly, M. D., and J. H. Mac- 
Donald, M. D. 

Reports were read and accepted. 

Doctors Hill, Dolloff and Dennett were appointed 
as a committee to draw up resolutions on the 
deaths of Doctors Randall and Weeks. 

Doctors Hill and MacDonald were appointed to 
take charge of the April meeting to be held at 
Ivennebunk, Maine. 

W. L. Morse, M. D., of Springvale was elected a 
member of the Society. 

Following the business, the meeting was given 
over to the Chairman, Frederick T. Hill, M. D., of 
Waterville, who conducted a Panel Discussion on 
Pneumonia. The topics were: 

Examination and History, T. E. Hardy, M. D. 

Surgery, S. A. Cobb, M. D. 

Heart, E. H. Drake, M. D. 

X-ray, Langdon Thaxter, M. D. 

Pathology, Julius Gottlieb, M. D. 

Medical and Summary, E. R. Blaisdell, M. D. 

This Panel Discussion, which will be sponsored 
by the Maine Medical Association, during the year, 
will later appear in the Journal of the Maine 
Medical Association. 

A record on dues was established at this meeting, 
as there was a hundred per cent payment on all 
those present. 

C. W. Kinghorn, M. D., Secretary. 


York 


New Members 


The annual meeting of the York County Medical 
Society was held at the Normandie, in Scarboro, 
January 4, 1939, at 2 o’clock, preceded by a dinner. 

Election of officers followed, the nominating com- 
mittee consisting of Drs. Dolloff, Perrault and 
Paul Hill, Jr. 

Officers elected were: 

President, Dana B. Mayo, M. D., South Eliot. 

Vice-President, W. T. Roussin, M. D., Biddeford. 

Secretary - Treasurer, C. W. Kinghorn, M. D., 
Kittery. 


Knox 

Gilmore Soule, M. D., Rockland. 
John B. Curtis, M.D., Thomaston. 


Penobscot 

J. Robert Feeley, M. D., Bangor. 


York 

W. L. Morse, M. D., Springvale. 


Coming Meetings 

Kennebec 


Kennebec County Medical Association, Frederick 
R. Carter, Augusta, Secretary. 

February 16, 1939, at the Elmwood Hotel in 
Waterville, Maine. Panel Discussion — Pneumonia. 
March 16, 1939, at the Augusta General Hospital. 


April 20, 1939, at the Gardiner General Hospital. 
Speaker: Samuel Levine, M. D., Boston. Subject: 
The Ausculation of the Heart. 

May 18, 1939, at the Veterans’ Administration at 
Togus, Maine. 


38 


The Journal ol the Maine Medical Association 


Knox 


Knox County Medical Society, A. J. Fuller, M. D., 
Pemaquid, Secretary. 

The next meeting of the Knox County Medical 
Society, with Dr. H. L. Apollonio, President, will 
be held Tuesday, February 14th, at 7.00 P. M., at 
the Copper Kettle, Rockland, Maine. 


The guest speaker of the evening will be Dr. 
Everett D. Kiefer, of the Lahey Clinic, who will 
speak on The Management of Ulcerative Colitis 
and Functional Colonic Disorder. Dr. Clapp of 
Lewiston will discuss this paper. 


*> — -» 

Necrologies 


Francis O. Hill , M. /). 

Dr. Francis O. Hill, 65, of Monticello, died at his 
home January 2nd, after an illness of some four 
years. Dr. Hill graduated in medicine from Bow- 
doin Medical College in 1899 and for a year was 
associated with an uncle, Dr. F. O. K. Hill of 
Brewer. He came to Monticello in 1900 and for 
many years carried on an extensive country prac- 
tice. He was a past president of the Aroostook 
County Medical Society, served as a member of the 
Maine Legislature in 1907 and during the world 
war was a Member of the Medical Advisory Board 
for southern Aroostook. 


Robert J . Kincaid , M. D. 

Dr. Robert J. Kincaid, 75, for 44 years a prac- 
titioner in Mars Hill, died at his home in that 
town on January 1st. Dr. Kincaid was a member 
of the Aroostook County Medical Society and for 
many years was a prominent and well-known prac- 
titioner in Aroostook County. He graduated in 
medicine from Bowdoin Medical College in 1891 
and with the exception of three years in Wash- 
burn and one year in Somerville, Massachusetts, 
lived and practiced in Mars Hill. 




Notices 


American Medical Association 
Council on Physical Therapy 

The American Medical Association has a num- 
ber of motion picture films for loan, among which 
are several on Physical Therapy. The borrower is 
expected to pay the expense both ways and is ex- 
pected to be careful when running them. 

Dr. Thomas G. Hull, Director, Scientific Exhibit, 
535 N. Dearborn Street, Chicago, Illinois, has 
charge of the distribution. 

Howard A. Carter, Secretary. 


Tumor Clinics * 

Portland: Maine General Hospital — Thursday, 

11.00 A. M.-12.00 M. Director, Mor- 
timer Warren, M. D. 


Lewiston: Central Maine General Hospital — 

Tuesday, 10.00 A. M.-12.00 M. Di- 
rector, E. V. Call, M. D. 

St. Mary's General Hospital — Wednes- 
day, 4.00 P. M. Director, R. A. Beli- 
veau, M. D. 

Waterville: Thayer Hospital — Thursday, 9.00- 

11.00 A. M. Director, Edward H. 
Risley, M. D. 

Sisters’ Hospital — Thursday, 9.00- 

11.00 A. M. Director, Blynn O. 
Goodrich, M. D. 

Bangor: Eastern Maine General Hospital — 

Thursday, 11.00 A. M.-12.00 M. 
Director, Magnus F. Ridlon, M. D. 

* Approved by Maine Medical Association. 


Volume Thirty, No. 2 


Book Reviews 


39 


Announcement 


The American Board of Ophthalmology an- 
nounces an important change in its method of 
examination of candidates for the Board’s certifi- 
cate. 

Examinations will be divided into two parts. 
Candidates whose applications are accepted will 
be required to pass a WRITTEN examination 
which will be held simultaneously in various cities 
throughout the country approximately 60 days 
prior to the date of the oral examination. 

Only those candidates who pass the written ex- 
amination and who have presented satisfactory 


case reports will be permitted to appear for the 
oral examination. 

Examinations scheduled for 1939 : WRITTEN : 
March 15th and August 5th. ORAL: St. Louis, 

May 15th; Chicago, October 6th. 

Applications for permission to take the written 
examination March 15th must be filed with the 
Secretary not later than February 15th. 

Application forms and detailed information 
should be secured at once from Dr. John Green, 
Secretary, 6830 Waterman Ave., St. Louis, Mo. 


Book Reviews 


“ Practical Microbiology and Public 
Health ” 

By William Barnard Sharp, S. M., M. D., Ph. D., 
Professor of Bacteriology and Preventive Medi- 
cine in the Medical Department of the University 
of Texas; Visiting Bacteriologist of John Sealy 
Hospital, Galveston; Supervisory Bacteriologist 
of Galveston Health Department. 

Published by The C. V. Mosby Company, 1938, 
St. Louis. Price, $4.50. 

This handbook is so designed as to aid the medi- 
cal student in organization, interpretation, and 
systematic recording of data from the field as well 
as from the laboratory. It is divided into eight 
parts. Each part contains the working schedule 
for the various fields to be investigated. The sub- 
ject matter is so arranged that it can be made to 
serve parallel with the didactic and practical work 
usually performed in the medical curriculum. The 
book covers not only bacteriology but subjects re- 
lated to public health as well. The working sched- 
ules are of sufficient elasticity to permit of their 
adaptation to courses of varying lengths. 


“Cancer — With Special Reference to Can- 
cer of the Breast ” 

By R. J. Behan, M. D., Dr. Med (Berlin), F. A. 
C. S., Cofounder and Formerly Director of the 
Cancer Department of the Pittsburgh Skin and 
Cancer Foundation, Pittsburgh, Pa. Published by 
The C. V. Mosby Co., St. Louis, 1938. Price, $10.00. 

Cancer in general is demanding a great deal of 
the time and effort of the medical profession both 
in the field of action of the general practitioner as 
well as in the fields of all the specialties. Cancer 
of the breast, especially of the female breast, is a 
very large and important special field within the 
all-comprehensive field of pathological new- 
growths commonly designated by the term “can- 
cer.” The author of this treatise begins with the 
exposition of the various characteristics of cancer 
in general, then limits his attention to the exten- 
sive description of the characteristics of cancer of 
the breast. He then goes thoroughly into the va- 
rious methods of treatment, operative, constitu- 
tional, irradiative, etc. Though no ideal specific 
test has yet been discovered but because some 
tests have been devised in the hope of event- 


ually making earlier diagnosis possible, the 
author reviewed many of the more promising tests 
for cancer. This is in accordance with his desire 
to make the book under review a complete unit. 
Those tests which have received most favorable 
recognition by the authoritative students of can- 
cer are described in detail. The one hopeful factor 
in prognostic value seems to be that in all of the 
published statistics on cancer, where the correct 
diagnoses are made early and where the appro- 
priate and most expert operative and irradiative 
treatment was instituted at once, fatal metastasis 
could be considerably reduced and life greatly 
lengthened. 

Concerning treatment, the author writes: “Can- 
cer is the most difficult and complex of all dis- 
eases to understand and its treatment demands an 
almost universal knowledge of medicine and of 
physics. Therefore, it seems logical to conclude 
that the cancer patient can be most effectively 
treated by those who have made a special study 
of cancer.” He devotes more than 350 pages to 
the exposition of various forms of treatment which 
have been found to be more or less successful by 
many expert and careful specialists in cancer 
therapy. 


“Twenty-Eight Years of Sterilization in 
California” 

By Paul Popenoe, Sc. D., and E. S. Gosney, B. S., 
LL. B., President of the Human Betterment Foun- 
dation. Published by the Human Betterment 
Foundation, Pasadena, Calif. Price, 25c. 

The study of this little publication seems almost 
to transmit to the reader the enthusiasm with 
which the authors describe the work done by many 
workers in accordance with the California eugenic 
sterilization law. They claim that eugenic steril- 
ization has progressed beyond the experimental 
stage. They seem to be convinced that “It is the 
consensus of opinion of students of the subject 
from a social and scientific viewpoint, that all 
evidence justifies sterilization as one of the indis- 
pensable measures that must be included in any 
fundamental and humanitarian progress for deal- 
ing with society’s increasing burden of mental 
disease, deficiency and dependency.” However, the 
medical profession as a w'hole, better than any 
other profession, knows that the factors which 


The Journal of the Maine Medical Association 


HO 


combine to form the foundations upon which the 
structures of mental disease, deficiency, and de- 
pendency develop, are extremely complex in na- 
ture and very difficult to discover. The problems 
which present themselves can but rarely be suc- 
cessfully solved by such over-simplified thera- 
peutic measures as the practice of active eugenic 
sterilization presents. 


“ You Can Sleep Well — The A B C’s of 
Restful Sleep for the Average Person ” 

By Edmund Jacobson, M. D. Published by Whit- 
tlesey House, New York, London. McGraw-Hill 
Book Company, Inc., 1938. Price, $2.00. 

Modern men and women, living through their 
days in restless activity, seem to have lost the 
instinct to relax in order to enjoy restful, refresh- 
ing sleep during the oncoming night, which in- 
stinct is naturally present in the child. The 
author of the book under review enumerates some 
of the many improper methods we all are apt to 
try at one time or another for the purpose of 
promoting relaxation and inducing restful sleep. 
Considerable space is used for the description of 
his six steps of “How to Sleep Well.” Two chap- 
ters are devoted to the laboratory methods of 
studying and measuring sleep under scientifically 
controlled conditions. The present work is an at- 
tempt to present to lay readers, in simplified 
language, the results of the author’s relaxation or 
rest method, developed and employed by him dur- 


ing the past thirty years, for the purpose of 
producing refreshing, restful sleep by means of 
very simple exercises. 


“ Biography of the Unborn ” 

By Margaret Shea Gilbert. Published by The 
Williams & Wilkins Company, Baltimore, 1938. 
Price, $1.75. 

The author possesses the rare and remarkable 
gift to be able to tell that part of man’s life story 
which has baffled man’s mind through all the cen- 
turies of historic evolution, and which still stimu- 
lates the scientific man’s mind of today to further 
research in a most charming manner. The life of 
the world’s greatest, as well as that of the world’s 
lowliest man, as it is lived from the moment of 
conception to the moment of birth, hidden away 
from the investigating eyes of the experimenter, 
far removed from the turmoils which torture the 
living, within his mother, is now told in a lan- 
guage which every man and woman of average in- 
telligence can understand. 

This part of the story of man’s progress in evol- 
ution as told by the biographer of the unborn be- 
comes increasingly fascinating when it is under- 
stood that “ever since ancient times men have 
conjectured and debated about the manner in 
which human life is started, and the means or 
events through which the child takes form within 
the mother.” When it is further understood that 
“the fact that sexual relationship always precedes 
the creation of a child was perhaps the only real 


Art Tells History of American Medicine 



“Beaumont and St. Martin” is the first of six 
large paintings in oil memorializing “Pioneers of 
American Medicine” which artist Dean Cornwell 
will complete in the next few years. Others in the 
series are: Dr. Oliver Wendell Holmes, Dr. Eph- 
raim McDowell, Dr. Crawford W. Long, Dr. Wil- 
liam T. G. Morton, and Major Walter Reed, and 
one woman, Dorothea Lynde Dix, who, while not a 


physician, stimulated physicians to study insanity 
and feeblemindedness. 

Arrangements to supply physicians with free, 
full color reproductions of “Beaumont and St. Mar- 
tin” without advertising, and suitable for framing, 
have been made with the owners, John Wyeth and 
Brother, 1118 Washington Street, Philadelphia. 


Volume Thirty, No. 2 


Book Reviews 


41 


information available to the early Greek philoso- 
phers,” but that “not until the nineteenth century 
did men finally realize that the union of the sperm 
and the egg creates a new human being,” the “Bi- 
ography of the Unborn” becomes most instructive 
reading. It is scientific literature of high degree. 
In addition, it is a masterpiece in literature which 
is accepted by well-known authorities. 


“ Medicine in Modern Society” 

By David Riesman. Published by the Princeton 
University Press, Princeton, 1938. Price, $2.50. 

This is a pleasingly written and highly instruc- 
tive epitomization of the history of medical prog- 
ress. In less than 225 pages the author spreads out 
before the reader’s eyes the many centuries dur- 
ing which man has tried to evolve ways and meth- 
ods by means of which he could reduce or abolish 
his own suffering as well as that of his fellow 
human beings. In stylishly attractive and readily 
understandable language, the march of progress in 
the medical sciences is traced through some 3,500 
years of human efforts at civilization. By pre- 
senting and elaborating on the work of the various 
outstanding personalities of the several epochal 
periods of progress made in several countries, the 
author provides the physician as well as the in- 
telligent layman with easily accessible data by 
which may be measured man’s success at solving- 
some of the complex problems which present them- 


selves daily in most everyone’s life. The lessons 
taught by the master minds of antiquity are then 
skillfully adapted to the needs of our present-day 
requirement in our more highly complicated civ- 
ilization. The American way of solving our own 
problems is highly recommended but it is shown 
that greater progress of a more lasting quality 
can be expected if more attention is paid in the 
future to the lessons taught by the errors made in 
the past. 


“Drug Addicts Are Human Beings” 

By Henry Smith Williams, M. D., B. Sc., LL. D. 
Published by the Shaw Publishing Company, 
Washington, D. C., 1938. Price, $2.50. 

When a man has written more than one hundred 
books, the one under review being the author’s 
one hundred and nineteenth, even a fault-finding 
reviewer could not retard the progress of such a 
dynamic personality. 

In the present volume Dr. Williams presents for 
the first time the truth as he sees it concerning 
the origin and development of the Narcotic Code. 
He shows by way of documentary evidence the 
almost unbelievable cruel workings of one of 
America’s great industries, the “Illicit Drug Traf- 
fic,” also called “dope” racket or “billion-dollar 
racket.” The purpose of the book is the full ex- 
position of the shameful and humiliating record 
of this enterprise. 


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The Journal of the Maine Medical Association 


The basic law which is commonly known as the 
Harrison Narcotics Law was passed by Congress 
on December 17, 1914. This law put the entire 
handling of narcotic drugs into the hands of phys- 
icians. In 1921 an “advisory” leaflet was issued, 
allegedly based on the Harrison Law, which was 
in effect a code, and which in reality far transcend- 
ed the powers of that law, and which was destined 
to transform the entire narcotic situation in 
America. “The Code denied the physicians any 
voice in the use of narcotics for treatment of the 
particular type of patients believed to be in the 
minds of the lawmakers. And in that denial, lay 
the germs of the entire bizarre development. The 
entire tragedy, with its legal, medical and eco- 
nomic bearings, lay engermed in the simple order 
which forbade physicians to treat ambulatory pa- 
tients suffering from addiction disease.” Never 
before has the perilous position of every dutifully 
and conscientiously practicing physician been so 
clearly presented to the physician himself as well 
as to the layman as in this book. 


“ Feminine Hygiene in Marriage ” 

By A. F. Niemoeller, A. B., ML A., B. S. Author 
of American Encyclopedia of Sex, Men Past Forty, 
etc. Published by Harvest House, New York, 1938. 
Price, $2.00. 

A clear common sense presentation of common 
problems told in common sense language to the 
common people is always a welcome addition to 
the rapidly growing semi-scientific lay literature. 
The problems of female sexuality are taken up 
progressively and discussed. If common sense so- 
lutions are known, they are named. If medical 
remedies are needed they are indicated. Self-medi- 
cation is strongly advised against. When abnor- 
mal functioning of the female genito-urinary sys- 
tem is encountered, the reader is most strongly 
advised to consult her physician. The book is pri- 
marily addressed to the married woman and its 
purpose is to promote her health and marital hap- 
piness, and is based upon the common knowledge 
that many wives are rather careless in their prac- 
tice of feminine hygiene. “The book is intended 
only to help the woman in the daily personal and 
intimate care of herself and is not to be considered 
a manual for the self-treatment of disease or dis- 
ease conditions.” 


“How to Conquer Constipation ” 

By J. F. Montague, M. D., Editor-in-Chief of 
Health Digest Medical Director, New York Intes- 
tinal Sanitarium; American Association for the 
Advancement of Science; American Society for the 
Control of Cancer; Late of University and Belle- 
vue Hospital Medical College; Fellow American 
Medical Association; Fellow New York Pathologi- 


cal Society; Sometime Fellow New York Academy 
of Medicine and American College of Surgeons. 

Published by J. B. Lippincott Company, Phila- 
delphia, 1938. Price, $1.50. 

This small volume tries to present to the lay 
reader what is wise and otherwise in dealing with 
the problem of so-called constipation. The author 
describes in simple language simple methods by 
the application of which the apparently ever-pres- 
ent question: What shall I do about it? can be 
pragmatically answered in most instances. When 
doubtful situations arise or where pain, general 
and lasting discomfort, fever or hemorrhage are 
troubling symptoms, the author strongly advises 
his readers to consult the family physician who 
may then consult the proper specialist if this 
should become necessary. 


“Synopsis of Clinical Laboratory Methods ” 

By W. E. Bray, B. A., M. D. Professor of Clini- 
cal Pathology, University of Virginia; Director of 
Clinical Laboratories, University of Virginia Hos- 
pital. 

Published by The C. V. Mosby Company, St. 
Louis, 1938 

Due to the many advances in clinical laboratory 
methods during the last two years, the author 
found it necessary to put a new edition of this 
pocket book synopsis into circulation. A great 
many new procedure descriptions have been add- 
ed. Even though these descriptions are purposely 
brief in order not to increase the size of the book 
too much, the directions given are considered 
quite adequate for successful performance of the 
various tests if they are closely followed. 


“The Practice of Medicine” 

By Jonathan Campbell Meakins, M. D., LL. D., 
Professor of Medicine and Director of the De- 
partment of Medicine, McGill University; Physi- 
cian-in-Chief, Royal Victoria Hospital, Montreal; 
Formerly Professor of Therapeutics and Clinical 
Medicine, University of Edinburgh. Fellow of the 
Royal Society of Edinburgh; Fellow of the Royal 
Society of Canada; Fellow of the Royal College 
of Physicians, London; Fellow of the Royal Col- 
lege of Physicians, Edinburgh; Honorary Fellow 
of the Royal College of Surgeons, Edinburgh; Fel- 
low of the Royal College of Physicians, Canada; 
Fellow of the American College of Physicians. 

Published by The C. V. Mosby Company, St. 
Louis, 1938. Price, $12.50. 

Among America’s best one-volume textbooks, 
“Meakins” certainly deserves an honorable posi- 
tion. Quite correctly the author elaborates more 
upon the great many varieties of those diseases 


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Volume Thirty, No. 2 


Book Reviews 


4.3 


and their symptoms and treatment which are not 
ordinarily accessible in all the medical centers 
during the young doctor’s training in school as 
student, or in the hospital as interne. The fre- 
quently-occurring diseases impress themselves 
readily enough during these formative years as 
memorable experiences. It is those rarely seen 
cases which frequently confront the general prac- 
titioner, especially in times like the present, where 
the exchange of labor between the various states 
and various nations is so widely practiced, which 
the author brings before the reader. It frequently 
happens that apparently healthy migrants come 
from territories where certain epidemic or en- 
demic diseases circulate freely. To be able to rec- 
ognize the first sporadis case in one’s community 
often prevents a serious spread. A great many of 
the excellent illustrations incorporated in this text 
are so clearly illustrative of such cases which are 
more or less unusual in everyday practice that 
the disease suspected can be readily recognized 
when patient and physician meet. 

The material contained in “Meakins” is reliable, 
the remedies recommended have been tried in ac- 
tual practice, modern discoveries have been in- 
cluded if found practicable, functional pathology 
is properly evaluated, and sub-clinical aspects are 
clarified whenever this was possible. 


“ Clinical Laboratory Methods and 
Diagnosis ” 

By R. B. Gradwohl, M. D. Published by C. V. 
Mosby Company, St. Louis, 1938. Price, $12.50. 

“Gradwohl” is positively the most monumental 
creation of its kind so far produced in the Ameri- 
cas as far as this reviewer has been able to ascer- 
tain. That the author intends to keep the subject 
of clinical laboratory methods and diagnosis fully 
alive and abreast with the times is fully evidenced 
by the fact that after three short years he found 
it necessary to thoroughly revise his first work. It 
seems that almost every task can be handled suc- 
cessfully with the help of the present text. The 
two largest sections, hematology and helminthol- 
ogy received considerable revisorial attention. 

It must be considered most beneficial to physi- 
cians everywhere that such a far-reaching field as 
Parasitology and Tropical Medicine presents was 
elaborated so remarkably well with the collabora- 
tion of Professor Pedro Kouri of the Medical 
School of Havana, Cuba. Americans like to travel 
and travel within the Americas exposes them to 
the various disease-producing organisms that pre- 
vail somewhere on our hemisphere. Professor 
Kouri shows with most excellent microphotographs 
all of the distinguishing characteristics of the 
more common tropical and subtropical parasites. 
Almost three hundred pages are devoted to this 
and allied subjects. More than a hundred pages 
have been added to the chapter of hematology, 
making a total of four hundred twenty-seven 
pages. Complete data on the various theories of 
blood development are given. Twenty-four full 
page color plates have been added. Forty-six varie- 
ties of blood cells are described. The Schilling 
theory is more thoroughly elaborated. 

It is a magnificent work, and when the diligent 
and faithful worker has overcome a certain feel- 
ing of awe which may come over him for a mo- 
ment when he is confronted by the wealth of use- 
ful information and the multitude of tests by 
means of which further information must be 
laboriously obtained in the name of scientific 
medicine, he will find “Gradwohl” to be his most 
reliable consultant. 


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JONES’ PRIVATE SANITARIUM 

UNION, MAINE 

Founded 1908 

For mild mental and nervous cases, invalids 
and aged people. 

Combining the comforts and attentions of home 
life with the care and treatment of physician 
and nurses. Beautifully situated on State High- 
way 17, twenty-eight miles from Augusta and 
fifteen miles from Rockland. Capacity, thirty 
beds. 

For booklet, address, 

Paul A. Jones, M. D., Superintendent 
John Kazuxow, M. D., Resident Physician 
F. G. Campbell, M. D., Warren, 

Consultant Physician 

Telephone: 27 



DR. LEIGHTON’S HOSPITAL 

PORTLAND, MAINE 
“A Private Institution for Women” 

Obstetrical, Gynecological and Female Surgical cases only 
received. Unusual facilities are offered. Operating room and 
labor ward entirely separated. All modern hospital neces- 
sities are available. 110 mg. of radium personally owned, 
which is used wholly for the treatment of uterine malig- 
nancy. Gas-oxygen apparatus. Laboratory. Trained nurses. 
Private rooms with sun parlors attached. Two-bed and 
three-bed semi-private rooms. Quiet, secluded location. 
Easily accessible. A nurses’ registry is maintained, through 
which the public or physicians may procure adequately 
trained nurses for obstetrical and surgical cases. For rates, 
illustrated booklet and further information please address: 

ADAM P. LEIGHTON, M. D. 

109 Emery Street, Portland, Maine 
Telephones: 4-0067 — 4-2858 


Index to Advertisers 


American Can Company VIII 

Blackwell, Elmer N XV 

Children’s Hospital, The VII 

Coca-Cola XIII 

Frye Company, Geo. C XII 

Gay Private Hospital VII 

Hood’s XV 

Jones’ Private Sanitarium XI 

Leighton’s Hospital, Dr XI 

Lilly & Company, Eli X 

Mead Johnson & Company XVII 

Medical Auditing Counsel XIII 

National Assn, of Chewing Gum Mfgs. . . . VII 

Nestle’s Milk Products, Inc 43 

New England Sanitarium IV 

Oakhurst Dairy V 

Old Tavern Farm XII 

Patch & Company, E. L IX 

Parke, Davis & Company XIV 

Petrolagar 1 1 

Physicians Casualty Association XII 

Prentiss Loring, Son & Co XIII 

Rich, S. S XV 

S. M. A. Corporation XVI 

Smith, Kline & French Laboratories ... VI 

State Street Hospital IV 

Surgeons & Physicians Supply Company XV 

Upjohn Company, The Ill 

Wescott Sanatorium, Dr. C. . P.. XV 

Wyeth & Brother Inc., John 41 

Zemmer Company, The 42 


Patronize Your Advertisers 



The Journal 

of the 

Maine Medical Association 


Uolume Thirty Portland, Ulaine, Ularch, 1939 


No. 3 


The Doctor s Dilemma W hen and If the Government Goes Into 
the Practice of Medicine in a Big W ay* 

By Roger I. Lee, M. D.,f Boston, Mass. 


Many of the laity and indeed many of the 
Doctors are wondering what is behind all this 
tremendous discussion about the medical pro- 
fession. The terms used are often confusing : 
State Medicine, Socialized Medicine, etc. The 
hall-room boys, who write signed and solemn 
articles about this, that and the other, declare 
that the American Medical Association has 
been too conservative in its leadership. The 
sob sisters write harrowing tales of drunken 
fathers and destitute families. The villain of 
the piece seems to be the doctor. The heroine 
is the social worker and the hero is the young 
handsome politician who has studied eco- 
nomics and sociology and who has been 
elected on a reform platform of complete, 
perfect and free medical service for all and 
d — — the expense. The idea is naturally in- 
triguing. For after all it is the payment for 
the necessities of life that hurts. The idea of 
only paying for life’s luxuries has real allure. 
And so we have studied the costs of medical 
care and discovered that the people of this 
country pay more for their cosmetics, their 
candies, and their patent medicines than 


they do for their medical care. Then the 
doctors got busy with their Medical Econom- 
ics and vociferously claimed that socialized 
medicine is only state medicine, and words 
fail to describe what might happen when the 
government goes into the practice of medi- 
cine. 

But at this juncture some people get up 
and say, “And so what !”. 

And then this past summer there was a 
so-called Health Conference. At this Confer- 
ence before a carefully picked and packed 
audience, the report of the Interdepartmental 
Committee on Health, appointed by the 
President, was read. After this reading, the 
report was sent to the President, and now it 
has been sent by him essentially without rec- 
ommendations except for careful considera- 
tion as a Message and as a Health Program 
to Congress. 

The document starts out with obvious 
errors of fact as to the existing health and 
medical services in the United States. Upon 
this erroneous presupposition is built up the 
theory that if there is enough money ex- 


* Read before the Cumberland County Medical Society, Portland, Maine, January 27, 1939. 
t Trustee: American Medical Association. 


46 


The Journal of the Maine Medical Association 


pended, a health utopia will be attained. The 
early yearly costs of the program will come to 
$850,000,000 a year for certain parts of the 
program and perhaps a total cost of nearly 
$5,000,000,000 a year for the full program. 
Actually, the five proposals are in no sense a 
health program, but proposals for govern- 
ment expenditures not only for preventive 
medicine and public health but also for those 
medical services which are concerned solely 
and exclusively with the treatment of the 
sick. It means the entrance of the govern- 
ment in a big way into the practice of 
medicine. 

Of course the Government is in the prac- 
tice of medicine now and has been for a long 
time. Some of us are old enough to have 
watched many of the steps which have taken 
place. In my own State of Massachusetts, for 
many years, the insane have been under gov- 
ernmental care. At first, the insane were a 
charge of the counties. However, there grew 
up such scandals that all of the county insane 
hospitals were taken over by the State, after 
which things improved very much. However, 
it was a private insane hospital then known 
as the McLean Asylum and now as the 
McLean Hospital, a department of the Mas- 
sachusetts General Hospital, which did the 
pioneer work in the merciful treatment of 
those unfortunately mentally ill and out of 
which developed the idea of positive and 
humane treatment as opposed to mere cus- 
todial care. 

I want to emphasize the fact that the 
original idea in the governmental charge of 
the insane was purely that of custody and 
not at all that of treatment. At the present 
time there are 23,733 beds in the State Insti- 
tutions for the Insane, and the budget is 
enormous. To this must be added over 5,000 
for the feeble-minded. These institutions are 
under the care of a Commissioner of Mental 
Disease. Hot so long ago, a capable Commis- 
sioner was ousted. His successor was a sick 
man who, to all intents and purposes, did not 
function except to draw his salary for a year. 
Obviously, the political possibilities are lim- 
itless. But perhaps even worse are the dis- 
couragement of the personnel, the loss of 
morale, and the difficulties of getting good 
men to take up this work as a career. 

The situation in Public Health in Massa- 


chusetts is more interesting and more illumi- 
nating. After all, the care of the Insane is a 
special problem, and so the Medical Profes- 
sion regards it. Early in the day came gov- 
ernmental water and sewage works. The ar- 
gument seemed simple. Water and sewage are 
necessary for the health of all the people and 
so, with very little opposition, the public or 
governmental ownership or control of water 
and sewage became an accepted fact. It all 
went along nicely, with public roads, public 
bridges, public ferries and public education. 
Here and there a private company operated a 
water supply, a road, or a bridge. In some 
instances, however, especially in higher edu- 
cation, private institutions challenged the 
general trend. 

At first, the Commonwealth of Massachu- 
setts passed laws in regard to certain diseases 
declared dangerous to the Public Health. Of 
course, notable among these was smallpox, 
and the early pesthouses were operated at 
public expense. Then, with the advent of 
vaccination, nothing seemed more reasonable 
than that the State should supply the vac- 
cine. Then came diphtheria, the free diag- 
nosis of diphtheria and the free supply of 
diphtheria antitoxin. The argument was that 
the prevention and cure of diseases dangerous 
to the public health were measures more for 
the benefit of the public health than for the 
patient. 

And so in Massachusetts we have nearly 
5,000 beds listed for the care of the tubercu- 
lous. A few of these are private charities, but 
mostly they are supported by State, county, 
and city or town funds. In the instance of 
tuberculosis, an interesting situation is slow- 
ly developing. The federal government, with 
its Veterans’ Hospitals, is also developing in- 
stitutional care for sick veterans. In the case 
of the Insane, institutional care lags behind 
the demand. In the case of tuberculosis, how- 
ever, the State, in order to keep its beds filled, 
has altered the policy of admitting only con- 
sumptives, the dangerous type of tuberculosis, 
by devoting some of the institutions to other 
forms of tuberculosis, as bone, joint, glandu- 
lar tuberculosis, etc., which are not dangerous 
to the public health. Indeed, the future brings 
up the problem of what disposition will be 
made of some of these tuberculosis hospitals, 
because the rapidly decreasing incidence of 


Volume Thirty No. 3 


The Doctor's Dilemma 


47 


tuberculosis will not require the existing 
amount of accommodations. 

However, we must stick for the moment to 
this movement in diseases dangerous to the 
public health. Nearly every one of those dis- 
eases has possibilities of laboratory diagnosis, 
and many of some specific treatment. Natu- 
rally we doctors want the best for our pa- 
tients, and sometimes the laity wants the 
newest before the profession has had oppor- 
tunity of testing the virtues of the latest 
remedy. The situation in pneumonia illus- 
trates our predicament. Just a short while 
ago, there were three recognized types of the 
pneumococcus, and the unrecognizable types 
were called Type 4. A reasonably effective 
serum was developed for Types 1 and 2, ap- 
parently more effective for Type 1 than for 
Type 2. This serum had to be administered 
by vein and often in considerable quantity. 
The actual cost ran from $30 to $100. Often 
it was difficult to determine the type. Fur- 
thermore, transfer of these sick patients any 
distance to a hospital often did the patient 
more harm than the serum did good. Almost 
overnight we were amazed to find that in- 
stead of four types of pneumococci we had 
over thirty. That necessitated more elaborate 
laboratory procedures to identify the type 
and more elaborate work with horses and 
other animals to develop these other sera. 
And now again overnight we are furnished 
with a new chemical, a kind of relative to the 
chemical known as sulfanilamide which we 
have just learned how to pronounce and spell 
and use. And just now no one knows whether 
all the serum treatment of pneumonia is anti- 
quated or not. Anyway, the profession is all 
excited about it, and the doctors with their 
humanitarian impulses are only interested in 
what is going to help their patients with 
pneumonia. 

There is one more group of diseases which 
is being taken over by the public health 
authorities, namely the venereal group, chief- 
ly gonorrhea and syphilis. In the case of 
syphilis, a strong case is made by the public 
health officials. The laboratory diagnosis is 
complicated but accurate. The treatment is 
long, technical and expensive. In any event, 
an extraordinary campaign against venereal 
disease has begun. All the modern technique 
has been utilized; there has been the prelim- 


inary campaign of education, the build-up or 
the “ballyhoo,” etc., etc. 

Most of us doctors have gone along, al- 
though it is all strange to us. We see every 
day naked emotions, tragedy, every form of 
drama, every kind of sorrow and joy. But 
these grand, dramatic spectacles of human 
emotion portrayed publicly are foreign to us 
and run counter to our notions of the privacy 
of the patient-doctor relationship. However, 
as I have said, to this point the practicing 
doctor has gone along with the trend of the 
times. On occasion he has resented some 
actions that he felt interfered with his prac- 
tice. Again, he may have felt unnecessary 
encroachment of the field of practice. But by 
and large, this whole movement has been 
initiated by doctors and has been supported 
by the doctors. The organized medical pro- 
fession was the first to preach public health 
and the first to seek its enactment in law. 

Inevitably, however, this movement has 
spread, and of late has seemed to gather new 
impetus. 

If insanity, feeble-mindedness, tuberculosis, 
and all the diseases dangerous to the public 
health are the responsibility of the govern- 
ment, are not all forms of health and disease 
the responsibility of the government ? And so 
the movement attempts to include chronic 
diseases, arthritis, cancer, old age, heart dis- 
ease, etc., as possible public services ! And 
beyond those, any disease ! Ought not the 
federal government, besides having hospitals 
for veterans, have hospitals for ordinary folk, 
perhaps beginning with diagnostic centers ? 
There are suggestions that the U. S. Public 
Health Service start up some diagnostic cen- 
ters in those large areas where there are said 
to be no hospitals, or inadequate hospitals. 
But there is dispute as to the existence of 
such areas. 

Again, one federal department, the Home 
Loan Owners’ Corporation, or something of 
that sort, donated $40,000 to start a federal 
health insurance scheme under lay control in 
the City of Washington, D. C. Whereat 
there was acrimony, hard words, lawsuits, 
and other results in the District of Columbia, 
and the end is not yet. It is hardly a coinci- 
dence that suit is being brought against the 
American Medical Association as a monopoly 
just at the time the health program is sent to 


The Journal of the Maine Medical Association 


U8 


Congress. Anyway, the doctors have several 
hundred schemes of their own to counteract 
this trend. If one attempts to look at the 
situation dispassionately, it appears that 
generally speaking the government, federal, 
State, county, and municipal, has taken over 
the custodial care of the Insane, and not only 
the custodial care but various preventive, 
including diagnostic and therapeutic, meas- 
ures in that large group of diseases often 
called the infectious diseases or the diseases 
dangerous to the public health. Within this 
preventive category come the governmental 
responsibility for water and sewage. This 
leaves the practicing physician the care of the 
individual sick. Such a division of medical 
practice has been very rapidly arrived at. 
And some of us can readily remember when 
there was little or no division, no state labora- 
tories, no tuberculosis hospitals, no venereal 
disease programs and few boards of health 
worthy of the name. 

But we hear demands for hospitals for 
arthritis, hospitals for cancer, hospitals for 
heart disease, all to be maintained by the 
government. It has seemed to some of us that 
certain circumstances which have existed 
since 1929 have much to do with the present 
situation and present uncertainty. I refer in 
part to the economic condition of this coun- 
try. In the first place, the medical profession 
has, by its prodigious advances and discover- 
ies, saved lives and increased the duration of 
life. If there had been no saving of life and 
no prolongation of life during the last fifty 
years over the previous fifty years, there 
would be no unemployment today. In other 
words, Medicine can and does save lives 
faster than Industry can find employment 
for them. But in the years just before 1929 
when there was little or no unemployment, 
one heard little or nothing of the inability of 
the poor to get adequate medical service. The 
doctors themselves took all in their stride, 
rich and poor. And in fact there were hos- 
pitals for the poor before there were hospitals 
for the rich. Somehow or other we doctors 
staggered through the worst of the depres- 
sion, and this is more than can be said of 
some of the other professions and of many 
businesses. And the doctors are still saving 
lives and prolonging life. But the load of 
carrying the whole load of the indigent sick 


has become increasingly difficult. Our doc- 
tors and our hospitals may be considered as 
entitled to some economic readjustment. But 
it is not evolution and readjustment, even at 
the accelerated tempo of the last twenty 
years, that some want. It is change, complete 
and entire. Why change when our mortality 
and morbidity records are indeed remark- 
able ? Change just for change is the reply. 
Change, that enemy of reason and action, 
that anaesthetic of the intelligence, as Emer- 
son says. Change because the Economists tell 
us it is better. But we recall that these 
Economists assured us for economic reasons 
the Great War could only last a few weeks 
or a few months and that not one of these 
Economists predicted the Depression. 

Or perhaps Change because the politicians 
see possibilities there. Thirty dollars every 
Thursday kind of change or Eifty dollars 
every Friday. Obviously, it is better if 
alliterative. And perhaps there is a venal 
side. I do not affirm or deny this. I just 
suggest it. 

Education, which has been “socialized,” is 
ordinarily used as an illustration of govern- 
mental control of a profession. Indeed, the 
State Universities and State Medical Schools 
are used as glowing examples of completely 
satisfactory governmental activity in Medi- 
cine. There are great State Universities and 
great State Medical Schools. But there are 
few if any, I think, who would venture to 
suggest that there should be no privately 
endowed universities and medical schools, 
chiefly because the State Universities need 
the privately endowed Universities. And 
then, too, Politics raises its ugly head. In 
Massachusetts recently we saw the discharge 
of a competent Commissioner of Education. 
To be sure, Massachusetts does not have a 
State University (if we except Amherst State 
College) or a State Medical School. Yet the 
recent storm of scandal concerning the 
Teachers’ Colleges and possible misuse of 
funds, all of which have led to the removal of 
the nresent Commissioner, gives reason for 
pause and contemplation. 

At the Washington Conference held last 
summer, a health program was proposed call- 
ing for just under a billion dollars a year for 
the first year or so. Mow, I do not know what 
a billion dollars are, but I think it could be 

9 ' 


Volume Thirty , No. 3 


The Doctor’s Dilemma 


49 


spent, especially if the government builds 
many $2,500,000 hospitals for crippled chil- 
dren as it did in New Mexico. They could 
only collect thirty crippled children from 
New Mexico, and they did not have an ortho- 
pedic surgeon in the state ! 

Perhaps these teeming millions had noth- 
ing to do with the failure of the reappoint- 
ment of that veteran health officer, Dr. Henry 
D. Chadwick, in Massachusetts. It is part of 
the plan to spend much of these moneys 
through the State Health Departments. Any- 
way, the present incumbent in Massachusetts 
may prove to be an excellent man even if 
untried and supplanting a remarkably fine 
public official. Dr. Chadwick is the third of 
three fine public officials in Massachusetts to 
be fired for the offense of holding a key posi- 
tion. There are no others related to this 
discussion. 

Now, if all the insane, all the feeble- 
minded, all the tuberculous, all those afflicted 
with infectious diseases or those diseases dan- 
gerous to the public health, are looked after 
by the government, and if we add all the 
arthritis cases, cancer cases, and then again 
if all the indigent are cared for by govern- 
mental agencies, who are left for the ordin- 
ary doctors ? And here a new term has been 
invented, namely, the medically indigent, 
who embrace twenty to ninety-five per cent 
of the population. That is to say, if the fam- 
ily, on their budget plan, find themselves 
skimped bv payments on such necessities as 
the automobile, the radio with the television 
set, the overstuffed furniture, the fur coat, 
the trip to the New York World’s Fair next 
summer, and the trip to St. Petersburg, 
Florida, this winter, such a family is medi- 
cally indigent if a member gets appendicitis 
or becomes pregnant. Now it is proposed 
that for these medically indigent the gov- 
ernment build new hospitals, mostly for 
diagnostic purposes ostensibly, with basal 
metabolism, sedimentation rates, electrocardio- 
graphs, and X-Rays. But we all know that 
treatment will also come in. Then, of course, 
the Veterans and perhaps their families will 
all be treated by the government. And again, 
there is proposed a compulsory insurance 
plan for all workers. And now whom does 
the general practitioner treat, and how is he 
going to live ? The doctor has not any unem- 


ployment insurance. He has not any “work 
and wages” plan. He has not any old age in- 
surance. The others (that is, the political 
bureaucrats) are all generals, and he is the 
Mexican Army. 

I suppose that expressed in different ways, 
we were all brought up in the idea that the 
practice of medicine is the treatment of the 
sick and the prevention of disease. But now 
we are told that medicine is a part of eco- 
nomics, of sociology, of social welfare, or of 
social security. For myself, I confess that a 
good deal of the argument seems metaphys- 
ical. For example, which conies first, the 
chicken or the egg? Is illness the cause of 
economic disaster or economic inadequacy the 
cause of illness ? And how can we change the 
human and personal equation ? To me the 
sight of a splendid funeral means the query 
of a possible misuse of insurance money. And 
I am not much heartened by a description of 
the outlines (only general outlines, mind 
you, the so-called blue prints) of the national 
health program as I heard them portrayed by 
a representative of the Social Security Board 
in Washington. This representative, not a 
doctor, described briefly these general out- 
lines of a National Health Program and then 
went on to say that there had been consulta- 
tions with various national groups, including 
the American Medical Association, The Com- 
mittee of Physicians, The Social Service 
Workers, The American Osteopathic Associa- 
tion, and American Chiropractic Association, 
and then he stopped suddenly with a puzzled 
look, and after a bit of mumbling, went on. 
1 recognized that puzzled look and so would 
you, I think. It is the look that you spon- 
taneously put on when you receive not one 
but two sharp kicks on the shin under the 
table, coming from the direction of your wife, 
when you are in the midst of one of your best 
stories, forgetting for the moment that there 
is not any more ice cream, or that the Jew 
story is not so good if there are J ews there, or 
that the jail story will not seem funny to 
someone just out of jail, etc., etc. 

Now, we are all, I think, prepared to admit 
that the doctors are not all perfect. Our 
wives would not be everlastingly trying to 
make us over if we were. And as for the 
unmarried doctors, there would not be any if 
they were perfect. 


50 


The Journal of the Maine Medical Association 


As a trustee of the American Medical 
Association, I am even prepared to say that 
the American Medical Association is not 
perfect and that, while the Journal of the 
American Medical Association is the best in 
the world, nevertheless, the editor may not 
be perfect. And yet perhaps one reason for 
some clumsiness in handling some of these 
issues which are political rather than scien- 
tific is that the American Medical Associa- 
tion has been busying itself for years with 
professional and scientific matters. 

The Council on Medical Education and 
Hospitals of the American Medical Associa- 
tion is, I think it is fair to say, largely re- 
sponsible for putting out of business a large 
number of inferior medical schools, the most 
of which were only diploma mills. The Coun- 
cil on Chemistry and Pharmacy has done the 
most outstanding work in the world in the 
field of therapeutics. And these are only two 
activities of a considerable number, which 
include the publication of several scientific 
journals. But, as I have said, the doctors are 
not all perfect, but as a group they have met 
three great challenges. It is a commonplace 
that the advances in medicine have been pro- 
digious, and it has been a burden put on 
every doctor as he begins his practice that 
somehow, come what may, he must keep pace 
with these advances. 

When I was an interne, there were no 
Gastro-Intestinal X-Rays, no Wassermann 
test, no Salvarsan, no basal metabolism, no 
electrocardiograms, no blood pressure appa- 
ratus, etc., and the list is long. 1 almost 
added and those were the happy days. But 
we have kept abreast of the scientific times, 
just as we learned to drive a motor car and as 
we shall soon learn to drive an airplane. But 
that challenge we have met. 

Then, too, we have in times of War met 
the challenge of learning and practicing war 
medicine and war sanitation. That record is 
indeed a glorious one. 

The Medical Profession has met coura- 
geously the challenge of poor medical schools, 
poorly trained doctors, poor hospitals, and 
the like, and has of itself corrected those evils 
so that today the American Medical Profes- 
sion is the best in the world and its Medical 
Schools and Hospitals are also superior to 
those in any other country. 


Again, the Medical Profession has met the 
challenge of the indigent sick, and I doubt if 
there is an appreciable percentage of doctors 
who have not contributed their part in the 
alleviation of suffering in the poor. And in 
this connection I want to sav with all the 
emphasis at my command that such state- 
ments that a considerable fraction, such as a 
third or anything like it, of our population 
does not have reasonably adequate medical 
service on account of an inability to pay for 
it is silly, inexact and far from the truth. I 
will agree that some people who need medical 
attention do not receive it, but the reasons are 
not largely, if at all, due to the inability to 
pay but to ignorance, obstinacy, and credul- 
ity in quacks, patent medicines, etc. Indeed, 
the well-to-do are often less sound in their 
medical belief than the poor. 

I give you my own feeble views for what 
they are worth. We are living in times of 
change, and the practice of medicine has 
changed and is changing extraordinarily 
rapidly. It is probably a fact that in some 
respects the tempo of these changes is in some 
instances too slow and again too fast. We 
will meet these changes as we have met these 
changes in the past, courageously and, I hope, 
intelligently. 

As I see it, the pressing problems are in 
the main two. I purposely exclude the nor- 
mal and rapid development of preventive 
medicine and public health which will go 
along with the advances in scientific medi- 
cine. I exclude also a troublesome problem, 
the medical care of the indigent. That is 
acute and distressing, but it seems to me solv- 
able. I exclude deliberately compulsory 
health insurance because it inevitably be- 
comes political and therefore costly and in- 
efficient and because it is not suited either 
to our people or to our doctors and because 
wherever it has been tried under circum- 
stances much more favorable than would ob- 
tain in this country, it has not resulted in 
(1) better public health, (2) better doctors, 
or (3) better medical care. The two difficult 
and pressing problems are (1) continuing 
education of the doctor to improve the qual- 
ity of medical service and (2) better distri- 
bution of not just medical service but of the 
best medical service. The solution of these 
problems will give results in lives and health. 


Volume Thirty, No. 3 


National Institute of Health 


51 


Already tlie scene buzzes with experimental 
activities on these two problems. Literally 
hundreds of schemes of medical service dis- 
tribution are being tried. It is likely that no 
one scheme or plan will be suitable north, 
east, south and west. It is certain, however, 
that by intelligent trial and error a solution 
or solutions will be found far more readily 
than by theoretical and sentimental oratory. 

Then, too, our universities, our medical 
societies of all kinds are earnestly and zeal- 
ously striving to continue the doctor’s edu- 
cation. It is my belief that with the solution 
of these two problems we do not need any 
radical change in our social philosophy of 
medical practice. I do not believe that gov- 
ernmental expenditure on a colossal scale is 
a sound theory for the solution of any prob- 
lem. Money is not the universal remedy. 
The rich get the best medical service just as 
the poor by the exercise of intelligence and 
not merely by the use of money. And witli 
vast governmental expenditures come, as in- 
evitably as night follows day, the politicians. 

In general, I believe that the governmental 
activity should be directed toward preventive 
measures, public health and custodial care of 
certain special groups of patients. The doc- 
tors themselves would continue to care for 
individual patients, treat the sick and prac- 
tice, of course, individual preventive medi- 
cine. There may be at times conflicts between 
these two activities, but it seems to me to be 
intolerable that two great systems of medical 


practice should operate side bv side, the gov- 
ernmental and the private practice of medi- 
cine. If such a calamity should occur, the 
ultimate result is obvious, because the govern- 
ment is a camel and we know what happened 
when the camel was let partly under the tent 
of his kindhearted keeper. The doctor, like 
the kindhearted keeper, would be out in the 
wet. However, I believe that such a misfor- 
tune is by no means inevitable. 

I have elsewhere compared the Health 
Program now before Congress to a, Midsum- 
mer Might’s Dream, a very pleasant dream 
because everywhere there were streams of 
gold. And in this dream the streams of gold 
washed away all the diseases and there were 
only health and happiness in the land. But 
there was a rude awakening from this dream 
when rough voices shouted, “The Tide of 
gold is in.” And those rough voices were 
those of the politicians. 

And over the radio early Sunday morning 
of this week came this message : “Shortly 
before 1 a. m. (Eastern Standard Time) the 
Coast Guard received a message that the Erie 
had reached the Esso Baytown and was send- 
ing a doctor over in a small boat.” Just a 
nameless doctor, even as you or I, not on a 
panel, not on a shift, not on hours and wages. 
But in the dark of a Sunday morning, while 
most of the world slept, he took his bag and 
went in a small boat on his age-old mission 
of mercy. 


National Institute of Health 

Construction will be started immediately 
on two additional laboratory buildings and 
living quarters for II- of the medical officers 
and their families at the National Institute 
of Health, near Bethesda, Maryland, Dr. L. 
B. Thompson, Director of the Institute, an- 
nounced February lOtli. 

With the completion of these two new 
laboratory buildings and the National Can- 
cer Institute Building, which was started last 
November, Dr. Thompson said that facilities 
will be available at the Bethesda center for 
about 600 scientific investigators, laboratory 
technicians, and research workers. The In- 


stitute is concerned with many public health 
problems, ranging all the way from the con- 
trol of serums and vaccines to determining 
the number of hours which bus and truck 
drivers can work without suffering undue 
fatigue which endangers life on the highways. 

One of the new laboratory buildings will 
house the Divisions of Infectious Diseases, 
and Biologies Control. The other will be 
used by the Divisions of Chemistry, Pharma- 
cology, and Zoology. It is expected that the 
Cancer Institute will be completed early in 
July of this year, and the laboratories at 
Cambridge, Massachusetts, and in the Insti- 
tute buildings at 25th and E Streets, will be 
moved into the new building at that time. 


52 


The Journal of the Maine Medical Association 


Treatment of Genito-Urinary Infections with Sul ph anil amide 

By George A. Sciineidee, M. D., and Michael J. Harkins, M. D., Lewiston, Maine 
Department of Urology, Central Maine General Hospital 


la. Patients should he closely followed 
and a complete blood count done every two 
days, while under moderately heavy dosage 
therapy. 

lb. Snlphanilamide is not successful in 
removing infection where there is obstruction 
to urinary output as: calculi, etc., or where 
there is little or no function, as in pyone- 
phrosis. Of course, this drug should be used 
with extreme care where there is kidney dam- 
age showing casts, increased 1ST. P. N. and 
diminished dye elimination (Psp. test). 

2. Toxic symptoms calling for immedi- 
ate cessation of snlphanilamide are: unex- 
plained fever, jaundice, dermatitis, anemia, 
agranulocytic angina and blurring of vision 
(may be seen in heavy smokers). ISTausea 
and dizziness often precede or accompany the 
anemia, which is of a hemolytic type. In the 
event of toxic manifestations of the drug, 
force fluids, per os or parentally, to rid pa- 
tient of the drug rapidly. 

3. The anemia does not respond readily 
to liver and iron therapy and it is better to 
transfuse these patients. If the drug is again 
started on these people who have exhibited 
an anemia, after they have had a rest period, 
they very often relapse. 

4. Anorexia, nausea, vomiting, dizziness, 
headache and cyanosis are common com- 
plaints while a patient is under sulphanila- 
mide therapy but per se. they are not contra- 
indications to sulphanilamide therapy. The 
cyanosis may be abolished for 8 or 10 hours 
by intravenous injection of 1 c. c. of methy- 
lene blue. 

5. Patients exposed to strong sunlight 
while under moderate or heavy therapy, may 
exhibit a fine erythematous rash. 

6. No drug should be given with the S0 4 
radical, and eggs should be eliminated from 
the diet. No laxatives are given and for bow- 
el stasis, s. s. enemas are used. Some employ 
mineral oil ;, sulphanilamide is not oil soluble 
so that mineral oil does not interfere with 
therapy. 


7. In adults the urinary output should 
be limited to 1000 c. c. or approximately 
1500 c. c. intake, in order to maintain con- 
centration of the drug. Only 50% of the in- 
gested sulphanilamide is active, the rest is 
excreted, coupled with an acetyl radical 
which is inactive. 

8. The drug should be given for three 
days, in the event the patient does not show 
earlier clinical improvement, as it takes about 
this time to saturate the body. 

9. Over a 24-hour period, we give 90 to 
100 grains of sulphanilamide to an adult 
weighing 150 lbs., for three days, then cut 
the dosage to 60 grains for the next ten days. 
In acute infections, the drug should not be 
discontinued after three days’ therapy shows 
amelioration of clinical symptoms, as the in- 
fection may again occur and it is more diffi- 
cult the second time to acquire clinical im- 
provement. Bicarbonate of soda is given with 
sulphanilamide. We give a 2 to 3 ratio, i. e., 
10 grains of bicarbonate of soda with 15 
grains of sulphanilamide. 

The high dosage therapy for children 
weighing 10 to 25 pounds is 2 grains per 
pound for the first 24 hours, then cut to 1 
grain per pound, for three days, then three- 
eights grain per pound. 

10. Sulphanilamide may be given by hy- 
podermoclysis ; it is soluble in the ratio of 
0.8 grams to 100 c. c. of distilled water. The 
distilled water is brought to a boil and the 
drug is stirred into it. Give sulphanilamide 
at 37 °C. If cooled it will crystallize out of 
solution. Solutions should be made up fresh 
each day. 30 c. c. of 1 / 2 % or 15 c. c. of 
1% sterile Novocain solution, added to 
500 c. c. of hypodermoclysis, makes this pro- 
cedure painless. 

11. In toxic patients, where no drugs 
could be given by mouth, we have obtained 
good results with Neo Prontosil solution, 
either 2 %% or 5%. It may be given under 
the skin with Novocain, as used without No- 


Volume Thirty , No. 3 Treatment of Genito-Urinary Infections with Sulphanilamide 


53 


vocain it causes burning in the subcutaneous 
area. We have given it by vein in physio- 
logical saline, or distilled water, as an emer- 
gency procedure. It has high diffusive pow- 
ers and rapidly appears in the urine. It may 
be used as an adjuvant to sulphanilamide, in 
early treatment. It is less toxic than sulpha- 
nilamide, although it is thought to be re- 
duced to sulphanilamide in the body. We do 


not recommend Neo Prontosil by vein except 
in emergencies, for rapid saturation of the 
body. Dosage of 2%% Neo Prontosil used 
lias been 1 c. c. per pound in adults, total 
dosage not to exceed 100 c. c. per 24 hours. 
For less than 25 pounds of body weight, it 
may be given in a dosage of 1.5 c. c. per 
pound. If 5% Neo Prontosil is used, divide 
this dosage by two. 


Gonorrheal Infections Treated with Sulphanilamide 


CHILDREN 

For children in this hospital, we use the 
dosage rule of %’s grain per pound for the 
first to third day inclusive, 8/15’s grain per 
pound for the fourth to seventh dav inclusive, 
%’s grain per pound for the seventh to 
twenty-first day inclusive. This is given with 


soda bicarbonate in the ratio of two parts to 
three parts of sulphanilamide. The drug is 
administered 4 i. d. at six-hour intervals. 
Children are more prone to the hemolytic 
anemia than adults. 

Adult gonorrhea may be best treated in 
bed, on high dosage therapy. 


Ambulatory Cases of Gonorrhea, Male and Female, Treated with 

Sulphanilamide 


In acute cases the drug seems to function 
better six to seven days after the active in- 
fection starts. We give 15 grains after meals 
and at bed-time, trying to get four hours be- 
tween doses, or a total of 60 grains per 24 
hours for 16 to 18 days, together with soda 
bicarbonate in the ratio of 2 to 3. If therapy 
is to be repeated, a three week’s rest between 
courses of sulphanilamide is advised. In 
chronic cases, 45 grains daily in divided 
doses (10 grains p. c. and 15 grains h. s.) is 
given for 21 days. Gonococcus vaccine twice 
weekly seems to aid the drug in these cases. 

Tobacco in various forms is said by many 
patients not to taste as well while under sul- 
phanilamide therapy and may cause dizziness 
if used a great deal. Alcohol acts svnergisti- 


cally with sulphanilamide to cause very se- 
vere dizziness, and should be emphatically 
forbidden while patients are under therapy. 

Ambulatory patients receiving sulphanila- 
mide therapy, who are employed around ma- 
chinery of various kinds such as belts, pul- 
leys, etc., should be closely questioned as 
regards dizziness. If they experience this 
symptom it is better that they be treated at 
home. Patients should also be warned against 
driving an automobile while under suphanil- 
amide therapy, as some very severe traffic ac- 
cidents have occurred as a result of this ther- 
apy. Ambulatory patients should be seen 
daily if possible, while undergoing sulpha- 
nilamide therapy. 


*t> *c^aJsVs*- 


Tucker and Hellwig emphasize the value 
of routine microscopic examination in procto- 
logic practice. One-third of their malignant 
lesions were discovered by histologic study of 
clinically benign lesions of the anal region. — 
F. E. K rebel, M. I)., The Southern Sur- 
geon , Dec., 1938. 


One candle power of intelligence applied 
in early diagnosis or in the elimination of the 
known precancerous situation will be far 
better than any million volts of irradiation 
for late cancer displays. — E. II. Skinner, 
Radiology, Oct., 1937. 


The Journal of the Maine Medical Association 


54 


Two Unusual Foreign Body Cases 

By Edward L. Pratt, M. I)., F. A. C. S.*, Lewiston, Maine 


The first case was a female child two and 
a half years old. She was admitted to the 
Central Maine General Hospital with the 
following history : 

The child was playing in a sand pile out 
in the yard when she suddenly choked and 
began to cough. When she “became blue in 
the face,” the mother put her finger down the 
child’s throat and the cyanosis cleared up and 
the coughing ceased. The child seemed all 
right until about two hours later when she 
was given some bread and milk which she 
promptly regurgitated. A little later she was 
again given some bread and milk and again 
it was regurgitated. On the advice of the 
family physician the child was brought to the 
hospital. 

On admission the child seemed to be in no 
distress. There was' no cyanosis, no cough, 
and no increase in respirations. None of the 
family could give any clue as to what the 
child had been playing with. An antero-pos- 
terior and lateral X-ray plate was made. The 
antero-posterior plate showed no evidence of 
a foreign body in either the food or air pas- 
sages. The lateral plate, however, showed a 
foreign body in the esophagus at about the 
level of the hiatus. It appeared to be about 
two cm. long and about the thickness of an 
ordinary paper match. Its long axis did not 
lie across the esophagus as if it were wedged 
there, but appeared to be straight up and 
down in the same plane as the esophagus. 
This caused us to wonder why a foreign body 
no thicker than a match should lodge in such 
a position at the hiatus. The radiographer 
thought that the shadow was too dense to be 
a piece of wood and that if it were bone, it 
ought to show on the antero-posterior view as 
well as the lateral. He then suggested that it 
might be a piece of glass, and on cross-exam- 
ining the mother it was learned that the child 
was fond of playing with glass. 

The child was taken to the operating room 
and a 7mm. Jackson esopliagoscope was 
passed slowly down the esophagus. The for- 


eign body was visualized at the level of the 
hiatus, but before a forcep could be inserted 
the foreign body had disappeared. The eso- 
phagoscope was passed slowly down to the 
cardia but still no foreign body was visual- 
ized. The child was immediately taken to the 
X-ray room but no foreign body was seen, on 
either antero-posterior or lateral plates, in 
the esophagus or in the stomach. It was as- 
sumed that as the esopliagoscope dilated the 
esophagus in the region of the hiatus that the 
foreign body slipped into the stomach. Food 
taken an hour later was not regurgitated. 
The stools were watched and two days later 
the foreign body was passed without any dis- 
comfort. It proved to be a rectangular piece 
of glass — like windowpane glass — measuring 
about 2 y 2 x 2 cm. and about as thick as a 
paper match. Its four corners were relatively 
smooth, probably because it had been in the 
sand for a considerable period. Had all four 
corners been sharp, it would have presented a 
very difficult extraction problem. 

The case is of interest in showing the value 
of always having a lateral as well as an 
antero-posterior X-ray plate, and also in 
demonstrating that this type of glass does not 
contain enough lead to show on its flat sur- 
face, but can be demonstrated bv X-ray if 
caught “on edge.” It is also rather remark- 
able that so large a foreign body, having 
passed the crico-pharyngeus constriction, did 
not also spontaneously pass the hiatal nar- 
rowing. 

The child suffered no ill effects from the 
accident and has remained well since then. 

The second case was an adult male 52 
years old. Before retiring he had his wife 
spray his nose and throat with a DeVillbiss 
atomizer fitted with a removable olive-shaped 
metal tip such as is used for spraying oily 
solutions. 

After spraying his throat his wife noticed 
that the metal tip was missing. The husband 
denied having swallowed it, felt no discom- 
fort in his throat, swallowed fluids easily, 


* From the Department of Broncho-Esophagology, Central Maine General Hospital, Lewiston, Maine. 


Volume Thirty , No. 3 


Two Unusual Foreign Body Cases 


55 


had no sensation of choking nor any cough. 
Prolonged search of the room failed to find 
the tip so he came to the Central Maine Gen- 
eral Hospital for an X-ray. 

When seen at the hospital he had no symp- 
toms of a foreign body in either the food or 
air passages. Indirect examination of the 
larynx was unsatisfactory because of gagging. 
Antero-posterior and lateral X-ray plates 
were taken. They plainly showed the atom- 
izer tip in the left pyriform fossa. 

A Jackson esophageal speculum was 
passed into the left pyriform fossa and the 


tip easily removed with a laryngeal alligator 
forceps. The fact that so large a foreign body 
as this can be swallowed without the patient’s 
knowledge and without causing any symp- 
toms illustrates how valueless is a negative 
history. Jackson (1) cites a case of a patient 
who had exactly the same kind of atomizer 
tip in the right bronchus one and a half years 
without knowing that he had inspirated it 
while spraying his throat. 

(1) Jackson, Chevalier, & Jackson, C. L. “Diseases 
of the Food and Air Passages of Foreign Body 
Origin,” Pg. 138. 


“The. Cheapest Thing Any Town Can Do 
With Syphilis Is To Cure It” 

That was the keynote of an announcement 
February 13th, by Dr. R. A. Vonderlehr, 
Assistant Surgeon General in charge of the 
Division of Venereal Diseases, United States 
Public Health Service, of a new nine-point 
program for syphilis control in the local com- 
munity. 

The program is outlined in a new publi- 
cation, “Syphilis and Your Town,” designed 
to assist local communities in making an 
adequate check upon the scope, effectiveness 
and facilities of local venereal disease con- 
trol projects. The nine points, set forth in a 
questionnaire intended to suggest best results 
from unified action bv local groups, are as 
follows : 

1. Do your State and town have a trained 
public health staff that knows how to deal 
with syphilis? 

2. Does your State require reporting and 
follow-up on all cases of syphilis ? 

3. Are patients in your town assured of 
good syphilis treatment even if they cannot 
afford to pay ? 

4. Do physicians and clinics in your town 
have access to free laboratory service for 
blood tests ? 

5. Do your State and town distribute free 
anti-syphilitic drugs to all physicians and 
clinics ? 

6. Is every expectant mother required to 
have a blood test in your State ? 


7. Are medical certificates, including a 
blood test for syphilis, required before marri- 
age in your State ? 

8. Does every complete physical exami- 
nation given in your town include the blood 
test ? 

9. Has your town an education program 
aimed at age groups most frequently acquir- 
ing syphilis ? 

Dr. Vonderlehr pointed out that public 
education is the crux of syphilis control, and 
added, “People must learn to consult a doc- 
tor or clinic. They must know that drug- 
store remedies and self-treatment are worth- 
less. They must know that treatment begun 
early will cure syphilis in nearly every case, 
while, if left untreated, the patient is likely 
to develop brain, heart, or nervous system 
complications.” 

“Syphilis control programs,” said the new 
publication, “should make provision for 
blood tests, not only for prenatal examination 
but as routine for every hospital patient 
and a part of every insurance examination. 
Life expectancy of untreated syphilitics is 
20 per cent lower than normal.” 

Dr. Vonderlehr concluded by insisting that 
the public must realize the cost of syphilis 
— its share in lives wasted, its toll in dollars. 
“All this is preventable if adequate control 
programs can be started and continued in 
every part of the country,” he declared. “It 
will be cheaper, too — the cheapest thing any 
town can do with syphilis is to cure it.” 


56 


The Journal of the Maine Medical Association 


Case Reports from Staff Meeting Held at the Thayer Hospital , 

January 26, 1939 

Dr. T. E. Hardy, Abstract Editor 


Dr. E. H. Risley: “A physician 57 years 
of age, with a negative past history, was taken 
with acute abdominal pain, nausea, vomiting, 
and fever following an 18-hour period of 
abdominal discomfort. Onset was compli- 
cated by a severe respiratory infection. There 
was complete lack of localizing signs, but 
there was a question of some resistance in the 
left lower quadrant. White blood count was 
8,000, polys. 62%. X-Ray of chest was nega- 
tive. Flat plate of abdomen showed marked 
dilatation of jejunum. Coughing persisted in 
paroxysms. Distention became more marked, 
and signs gradually became localized to right 
lower quadrant. White blood count went 
subsequently to 18,000 and to 23,000 with 
95% polys. Operation, under spinal anes- 
thesia, revealed purulent fluid in the peri- 
toneal cavity, appendix at midline, ruptured 
at l 1 /} inch from base and containing two 
fecoliths. Abdomen was drained. Conva- 
lescence has been uneventful.” 

Dr. A. IT. McQuillan: “I saw this case in 
consultation. The disturbing feature to all of 
us was the delay in diagnosis, due to the 
early lack of localizing signs, the severe acute- 
ness of pain and the low white blood count. 
This was not an infectious process. I feel 
that a paroxysm of coughing may have 
started the fecolith, causing obstructive 
necrosis with subsequent perforation.” 

Dr. E. II. Risley: “I cannot quite agree, 
as I feel the peritonitis was of at least 24 
hours’ duration, that perforation occurred 
earlier.” 

Dr. F. T. Ilill: “Does not the early low 
white blood count denote obstruction rather 
than infection ?” 

In all curable and borderline cases wherein 
the emotional stability is good, patients 
should be told their true condition because it 
helps them to realize more fully the impor- 
tance of treatment and will insure a closer 
conformity to the rules and instructions of 


Dr. E. II. Risley: “There was unfortu- 
nate delay due to the question of pneumonia.” 

Dr. A. H. McQuillan: “There was a trace 
of bile and sugar in the urine. We had to 
consider pancreatitis.” 


Dr. E. R. Irgens: “Parotitis may be epi- 
demic, metastatic from infection, due to in- 
fection extending up to Stenson’s duct, or the 
so-called sympathetic type following abdom- 
inal operations. Another type is reported — a 
25-year-old woman, due to direct extension 
from acute otitis media. The cartilagenous 
portion of the external auditory canal has a 
cleft known as the Fissure of Santorini. The 
retro-mandibular portion of the gland bends 
around the condyle so that it really lies be- 
tween the canal and the condyle. In this case 
the discharge from the middle ear caused 
infection in the parotid by extension through 
the Fissure of Santorini.” 

Dr. R. L. Reynolds: “Would it be good 
surgery to drain these cases externally? I 
have seen cases where the facial nerve has 
been injured by so doing.” 

Dr. V. T. Hill: “Drainage should be 

carried out externally if the process does not 
subside or cannot be drained through the 
Stenson’s duct. There should be no danger 
of injury to the facial nerve if the procedure 
is properly done and the gland incised in a 
horizontal direction. Post-operative fistula 
can easily be taken care of.” 

<*%?» ♦ 

treatment and will increase the cooperation 
necessary for successful follow-up. — Dr. E. 
E. Downs, Dr. Hoke Wammock, and Dr. 
R. T. Artman, National Bulletin of the 
A\merican Society for the Control of Cancer, 
Jan., 1939. 


Volume Thirty, No. 3 Meeting of the New England Oto-Laryngological Society 


57 


Meeting of the New England Oto-Laryngological Society , April 13, 
1938, at the Massachusetts Eye and Ear 
Infirmary, Boston, Mass . 

Dr. William GIoodell, President: Dr. Werner Mueller, Abstract Editor 


Report of Several Interesting Broncho- 
scopies. Dr. Chester R. Mills, 
Boston. 

Case 1: A 16-vear-old girl gave a history 
of having inhaled one or more common pins. 
An antero-posterior X-ray showed one pin in 
the hvpopharynx, another apparently in the 
chest at the level of the second and third ribs. 
The first one was readily removed, the other 
could not be found either in the lung or in 
the esophagus. Study with the bi-plane fluoro- 
scope finally revealed that what was at first 
thought to be the pin in the chest turned out 
to be a broken hypodermic needle in the soft 
tissues of the shoulder. Past history showed 
that the patient had several years previously 
been given a hypodermic injection which had 
caused her to jump. 

Case 2: Male, 54 years old. This patient’s 
chief complaint was dyspnoea on exertion and 
after eating, frequent gastrointestinal upsets, 
eructations of gas, increasing constipation 
and precordial pressure. These signs had 
been increasing during the past five years. 
There was no loss of weight. Physical signs 
in the chest were consistent with compression 
of the lungs, especially on the right side. A 
preliminary diagnosis of extra-bronchial new 
growth was made. X-rays showed a mass in 
the right chest with the heart pushed to the 
left. Bronchoscopy was done under local 
anesthesia. There was complete blocking of 
the right main bronchus due to extra-bron- 
chial compression. Lipiodol injection showed 
several lobulated areas of air in the right 
pleural cavity. A barium meal and enema 
was given which showed a large diaphragma- 
tic hernia on the right side with the cecum 
and ascending colon in the right pleural 
cavity. 

Case 3 : A boy 10 years of age was referred 
from the Medical Service for persistent 
cough, failure to gain weight, dyspnoea and 


precordial pain. He gave a history of having 
been struck by a truck when he was five years 
old. He had several fractured ribs and a 
collapsed lung at that time. He spat up some 
blood and was in the hospital 10 days. Since 
then he has been in the wards of the Boston 
City Hospital in 1934, 1936, and 1937, be- 
cause of one or more of the above symptoms. 
Physical examination has always shown 
atelectasis of the left lower lobe. He had 
always been negative for tuberculosis. Two 
gastrointestinal series ruled out diaphragma- 
tic hernia although the signs were very suspi- 
cious. His last admission to the hospital was 
in December, 1937. Bronchoscopy showed 
the left main bronchus completely obstructed 
with displacement of the trachea to the left. 
Lipiodol was instilled through the Stitt 
catheter. The catheter passed into the left 
main bronchus but the lipiodol failed to flow 
into the atelectatic lung. The right lung was 
readily outlined. The Thoracic Service is 
now studying the case and the question of 
lobectomy is being considered. 

Relationship of Pituitary Dysfunction 
to Frontal Osteomyelitis and 
Petrositis. I)rs. Leighton F. John- 
son and George Levene, Boston. Re- 
port Read by Dr. Johnson. 

Following the work of Drs. Mortimer, 
Levene, and Rowe at the Evans Memorial on 
the typing of crania from the standpoint of 
pituitary dysfunction, the authors studied the 
incidence of osteomyelitis of the skull and 
petrositis through the medium of endo- 
crinology. 

They found that, cranial osteomyelitis of 
sinus origin and petrositis usually occur only 
in skulls showing anterior pituitary lobe over- 
activity. Such skulls are characterized by 
spongy, rarefied, vascular bone and hvper- 
pneumatization of the sinuses, mastoids and 
petrous pyramids. 


58 


The Journal of the Maine Medical Association 


Atelectasis of the Newborn. Dr. George 
O. Cummings, Portland, Maine. 

The author’s case was that of a newborn 
infant showing respiratory difficulty at the 
time of delivery by caesarian section. The 
baby had never cried vigorously and at birth 
a considerable amount of fluid had been 
drained from its pharynx by posture and 
aspiration. It had been given respiratory 
stimulants and subcutaneous saline and had 
at times been placed into an infant-size 
Drinker respirator. A chest X-ray showed 
atelectasis of the right upper lobe. This was 
in this case obviously not due to obstetric dif- 
ficulties nor had the mother been given an 
excessive amount of pre-operative medication. 

After having duly considered the usual 
causes of atelectasis and the fact that even 
massive post-operative collapse almost invari- 
ably clears in time with the shifting of the 
patient’s position, it seemed best to let the 
child alone. Direct laryngoscopy with aspira- 
tion was not done because of the shock it 
might cause. Seventeen hours after delivery 
the baby died of a sudden respiratory failure 
that suggested the sudden release of a mucus 
plug with a complete blocking of the trachea. 

After having discussed the various old and 
new methods of resuscitation, the author sug- 
gested that the bronchoscopists of the various 
hospital stall’s should instruct residents or 
attending obstetricians in the use of the 
laryngoscope in the newborn. 

Use of Physical Therapy in Otolaryn- 
gology. Dr. John L. Myers, Kansas 
City, Mo. By Invitation. 

This paper has appeared in full in the 
1937 Transactions of the American Academy 
of Ophthalmology and Otolaryngology. In it 

Schiller distinguishes carcinoma of the 
cervix from normal epithelium by three char- 
acteristics: First, the diseased area is ele- 
vated ; second, the surface is not smooth and 
shiny but somewhat dull ; and third, the car- 
cinomatous epithelium is somewhat opaque. 
— Walter Schiller, Pathology of the Cer- 
vix, Am. Jour, of Ohs. & Gynec., XXXIV: 
430-438, Sept,, 1937. 


the author discusses the physical and thera- 
peutical properties of the Spectrum of Radi- 
ation as well as the agents for the production 
of the various regions of this spectrum, from 
the humble hot water bottle to the most com- 
plex electrical apparatus. Tumors are classi- 
fied as to their response to radiation. The 
electrocoagulation of tonsils is put in its 
proper place. Sun worshippers are told that 
sunlight is only one of many vitalizing fac- 
tors necessary to prevent disease and to main- 
tain health. For those who wish to go into 
this subject more deeply, a bibliography of 
26 titles is added. The author’s conclusions 
are as follows : 

1. Progress is being made in the thera- 
peutic use of radium and the Roentgen- 
ray. 

2. The action of light, ultra-violet, infra- 
red, and luminous rays, has not been 
scientifically established, though evi- 
dence enough has been given to show 
that through further research it may 
prove to be a potent therapeutic agent. 

3. The medical and surgical use of heat 
produced by the infra-red rays and the 
Hertzian waves is of value in combat- 
ing disease. 

4. Much more research is necessary before 
the full therapeutic value of energy in 
the spectrum is known. 

5. There must be closer cooperation be- 
tween and group work among physi- 
cians in order to secure optimum thera- 
peutic results. 

6. We must “try all things, prove all 
things, hold fast to that which is good.” 


If an exact diagnosis is made as soon as 
the patient notices unusual or irregular bleed- 
ing or an unusual or abnormal discharge, 
enough cancers can be discovered at an early 
stage so that the number of cures can be 
doubled.- — Arthur W. Erskine, M. D., in 
The American Journal of Roentgenology and 
Radium Therapy, Dec., 1938. 


Volume Thirty, No. 3 


The President’s Page 


59 


The President’s Page 


To the Members of the Maine Medical Association: 

As I write this President’s Page for the month of March, I cannot 
help but wonder if the members of the Maine Medical Association fully 
realize the amount of work that has been done by our Legislative Commit- 
tee and our Attorney, Mr. Locke, during the term of Legislature in the past 
month. Many undesirable bills have confronted us as well as questions to 
be decided relative to Medical Legislation, all of which have necessitated 
many miles of travel over icy roads and midnight lunches in diners. In 
fact, owing to our present dilemma, the Maine Central Railway is at last on 
the road to financial recovery. 

Furthermore, during the month of February it might be well for our 
members to know that we have been obliged to call two full meetings of 
the Legislative Committee, the first at Augusta, and the second at Hallowed. 

It also was necessary that we have a meeting of the Advisory Commit- 
tee at Portland, which was fully attended. This, however, was a pleasure 
because at that time we availed ourselves of the pleasant hospitality offered 
to us by our Chairman, Carl M. Robinson, M. D. This meeting was held at 
his colonial home at Falmouth Foreside, where a bountiful dinner was 
served followed by a pleasant evening spent around his large fireplace in 
his spacious living room. In fact, this was voted by all present as one of 
the bright spots of the year. 

Quoting our efficient Secretary Dr. Carter, “Everything is going to be 
lovely.” To this we heartily agree. But if so it is because of the fact that 
the members of our Legislative Committee have freely offered their time 
and money in order that they might honestly fulfill their duties as members 
of this Committee. Mr. Herbert Locke, our Attorney, and Dr. Frederick 
R. Carter, our Secretary, in their quiet and dignified manner have handled 
the situations as they arise in a way that would be complimentary to the 
officers of any organization. 

And in closing, I would ask each individual member during his hours 
of deepest thought to carefully analyze the situation as it is at the present 
day, and in the near future be prepared to lend their support to these diffi- 
cult problems that cannot possibly be decided by any one committee of our 
Association. 

Willard H. Bunker, M. D., 

President Maine Medical Association. 


6 o 


The Journal of the Maine Medical Association 


Editorial 

The Place of the Panel Discussion in a Program of Graduate 

Education 


In the past two years we have witnessed 
the general acceptance of the idea that Or- 
ganized Medicine must assume the respon- 
sibility for a continuation program of educa- 
tion, for the Profession. Hitliertofore any 
effort along this line was largely left to the 
initiative of the individual physician. To be 
sure the National and Sectional Medical 
Societies have carried on scientific programs 
of real merit for years, but these have re- 
sulted in but little progress in the education 
of the great mass of physicians, except inso- 
far as the publication of the proceedings 
reached and was assimulated by these men. 
State and County Associations tended to a 
degree toward scientific standards, but at best 
it was a sketchy and haphazard program 
which was presented. 

At last Medicine awakened to the fact that 
it had a definite responsibility. We assume to 
care for the physical ills of the people. There- 
fore we must see to it that people are ade- 
quately taken care of, that they have the best 
and most scientific medical attention. This 
means our practitioners must be abreast of 
the times and thoroughly cognizant of every 
advance that the Profession has made. Un- 
fortunately in the past it has been assumed 
that the responsibility for medical education 
rested largely with the medical school. AVe 
now must realize that this responsibility of 
the medical school ceases at the time of 
graduation, and yet a physician’s education 
must be continued, must go on from year to 
year, for Medicine is not static. Therefore 
where the initiative of the individual is lack- 
ing, Organized Medicine itself must assume 
this responsibility in order to provide the 
necessary modern scientific medical care 
which is so necessary for the well-being of the 
public. 

In the past few years, various programs 
have been tried in different states. Some have 
been most ambitious, some have been rather 
meager, some have been successful, some have 
been only fairly so. Conditions vary in dif- 


ferent states. The program most efficient for 
one might not fit conditions in another state. 
In our state, for example, we cannot hope to 
duplicate the extensive and ambitions pro- 
gram of Michigan. 

Here in Maine, for several years, we have 
been gradually and consistently improving 
the programs of our state meetings, bringing 
them up to a better educational standard. 
That this has been worthwhile is evident by 
the increased interest and attendance on the 
part of our members. We have constantly 
endeavored to improve the character of the 
County Association's programs and feel that 
considerable progress has been made. We 
have been peculiarly fortunate in respect to 
the fellowships available under the Common- 
wealth and Bingham Funds, which have 
enabled many of our practitioners to take 
much-needed post-graduate courses at no 
great personal sacrifice. But all these have 
not taken care of the great mass of our 
profession. Those who have attended our 
State meetings consistently have benefited. 
Those who have had the initiative to 
apply for post-graduate courses, and have 
been fortunate enough to have been able to 
have obtained these, have gained thereby. 
But still there seems to be the necessity of 
carrying this idea of Continuation Education 
further throughout the confines of our state. 
Just how to best accomplish this has been a 
problem which the committee on Graduate 
Education has assiduously studied. We have 
considered the idea of extension programs to 
he carried into the various Councilor districts 
and this may prove to be a valuable adjunct 
to our program. 

This past year we have endeavored to de- 
velop the panel system of program. This is a 
very popular and efficient type of program, 
of somewhat recent development, but one 
which has proven a most nsefnl means for 
disseminating knowledge. The panel discus- 
sion is now found on the programs of prac- 
tically all of the National Scientific Societies. 


Volume Thirty , No. 3 


With the Women's Field Army 


6 / 


Much more can be accomplished through this 
type of program than through any single or 
multiple set of papers. To those unfamiliar 
with the panel discussion perhaps a few 
words of explanation may not be amiss. 
Usually six or more men are assigned to a 
panel, each taking up some certain phase of 
the subject under discussion. Each man is 
usually confined to ten to fifteen minutes for 
his presentation. During his presentation 
any of the other men on the panel may inter- 
ject objections, questions, or any point that 
they wish to discuss. This makes it a lively 
continuous debate, rather than any series of 
set papers. Questions from the floor are sent 
up on paper and assigned by the Chairman 
of the panel to whatever member he feels 
most qualified to answer it. Should his 
answers not appeal to other members of the 
panel they immediately enter their objec- 
tions. In such a manner any topic can be 
thoroughly covered in approximately two 
hours and done in such manner as not to tire 


the audience, or allow them to lose interest ; 
something that could not happen were any 
one man presenting a paper. 

Already two panels have been prepared, 
on the subjects of “Pneumonia” and “Cardio- 
vascular Disease.” The former has been pre- 
sented at one countv meeting where it met 
with a great deal of interest. It is already on 
the program for a number of other counties. 
Two or three other panels on different sub- 
jects are now in preparation and will be 
available in the near future. It is felt that 
these offer some of the best opportunities for 
graduate education possible in Maine. County 
secretaries desirous of availing themselves of 
one or more of these panels are asked to 
write to the Committee on Graduate Educa- 
tion as early as possible, so that dates may be 
arranged. 

Frederick T. Hill, M. D., 
Chairman Committee on 
Graduate Education. 


With the Women s Field Army 

News from the Front 


Plans for the 1939 campaign of the Womens Field Army are being completed under the 
direction of the Volunteer Campaign Committee consisting of Samuel Stewart, Lewiston, 
Chairman; Mrs. John H. Huddilston, Orono ; Mrs. William Holt, Portland; Frederick T. 
Hill, M. D., Waterville; with Edward H. Risley, M. D., a member ex-officio. 

April has been designated as Cancer Control Month by the American Society. The in- 
tensive campaign will be carried on in most communities in Maine during the week of April 
third, although the entire month will be given over to the work, for the benefit of those groups 
who cannot carry on a campaign during the first week. 

Continuing the fine cooperation of the medical profession with the Women’s Field Army, 
the following physicians have accepted appointment as chairmen of the Advisory Boards in 
the districts throughout the State: 


ANDROSCOGGIN COUNTY: George H. Rand, 

M. D., Livermore Falls; W. E. Viles, M. D., 
Turner; Lester P. Gerrish, M. D., Lisbon 
Falls; John J. Busch, M. D., Mechanic Falls; 
George B. O’Connell, M. D., Lewiston-Auburn. 

AROOSTOOK COUNTY: Arthur T. Whitney, 

M. D., Houlton; Storer W. Boone, M. D., 
Presque Isle; Herrick C. Kimball, M. D., Fort 
Fairfield; Oscar Norrell, M. D., Caribou; 
Joseph L. Albert, M. D„ Fort Kent; Clyde I. 
Swett, M. D., Island Falls; and Albert H. 
Damon, M. D., Limestone. 

CUMBERLAND COUNTY: John M. Bischoff- 

berger, M. D., Raymond-Bridgton; Henry W. 
Beck, M. D., Gray; Howard Hamblen, M. D., 
Windham; Robert C. Pletts, M. D„ Brunswick; 
Louis L. Hills, M. D., Westbrook; Ervin A. 
Center, M. D., Sebago-Steep Falls; Robert B. 


Love, M. D., Gorham; Howard Sapiro, M. D., 
Scarboro; Nessib S. Kupelian, M. D., New 
Gloucester; Nat B. T. Barker, M. D., Yar- 
mouth; Harvey Howard, M. D., Freeport; 
John E. Gray, M. D., Cumberland; and Lang- 
don T. Thaxter, M. D., Portland. 

FRANKLIN COUNTY: George L. Pratt, M. D„ 
Farmington; Raymond B. Colley, M. D., Wil- 
ton; John H. Moulton, M. D., Rangeley; and 
Clarence Dunlap, M. D., Kingfield. 

HANCOCK COUNTY: Raymond V. N. Bliss, 

M. D., Blue Hill; John G. Chadwick, M. D., 
Bucksport-Tremont; Ralph W. Wakefield, 
M. D., Bar Harbor; George Parcher, M. D., 
Ellsworth; Charles Sumner, M. D., Hancock; 
B. Lake Noyes. M. D., Stonington; and 
Harold S. Babcock, M. D., Castine. 


6 2 


The Journal of the Maine Medical Association 


KENNEBEC COUNTY: Frank B. Bull, M. D., 
Gardiner-Hallowell; Greenleaf H. Lambert, 
M. D., Winthrop; Arthur A. Shaw, M. D., 
Clinton; Arnold W. Moore, M. D., Mt. Ver- 
non; Walter W. Hendee, M. D., Vassalboro; 
Ralph L. Reynolds, M. D., Waterville; and 
Vincent T. Lathbury, M. D., Augusta. 

KNOX COUNTY: William A. Ellingwood, M. D., 
Rockland; C. Harold Jameson, M. D., Cam- 
den; and Victor H. Shields, M. D., Vinalhaven. 

LINCOLN COUNTY: Stanley R. Lenfest, M. D., 
Waldoboro; Robei't W. Belknap, M. D., 
Damariscotta; DeForrest S. Day, M. D., Wis- 
casset; George A. Gregory, M. D., Boothbay 
Harbor; and Abbott J. Fuller, M. D., 
Pemaquid. 

OXFORD COUNTY: William M. Monkhouse, 

M. D., Fryeburg-Lovell; Roswell E. Hubbard, 
M. D., Waterford; Delbert M. Stewart, M. D., 
Norway-South Paris; Eugene M. McCarthy, 
M. D., Rumford; Horace J. Binford, M. D., 
Mexico; Charles W. Eastman, M. D., Canton; 
and Garfield G. Defoe, M. D., Dixfield. 

PENOBSCOT COUNTY: Forrest B. Ames, M. D., 
Bangor; Martin C. Madden, M. D., Old Town; 
Asa C. Adams, M. D., Orono-Veazie; Wesley 
C. MacNamara, M. D., Lincoln; Henry E. 
Whalen, M. D., Dexter; LeRoy H. Smith, 
M. D., Hampden-Orrington; Ernest T. Young, 
M. D., Millinocket; and George N. Higgins, 
M. D., Newport. 


PISCATAQUIS COUNTY: Albert M. Carde, 

M. D., Milo; E. D. Merrill, M. D., Dover-Fox- 
croft; Norman H. Nickerson, M. D., Green- 
ville-Monson; Ralph H. Marsh, M. D., Guil- 
ford; and R. C. Stuart, M. D., Sangerville. 

SAGADAHOC COUNTY: A. A. Stott, M. D., 

Bath. 

SOMERSET COUNTY: Harry W. Smith, M. D., 
Norridgewock; Maurice E. Lord, M. D., Skow- 
hegan; Merlon A. Webber, M. D., Pittsfield; 
Franklin Ball, M. D., Bingham; Percy E. Gil- 
bert, M. D., Madison; and Henry E. Marston, 
M. D., North Anson. 

WALDO COUNTY: Carl H. Stevens, M. D„ Bel- 
fast; and LeRoy H. Smith, M. D., Winterport. 

WASHINGTON COUNTY: William A. Van 

Wart, M. D., Cherryfield; Clarence W. Milli- 
ken, M. D., Jonesport; Oscar F. Larson, 
M. D., Machias; John L. Murphy, M. D., 
Eastport; Willard H. Bunker, M. D., Calais; 
John T. Metcalf, M. D., Lubec; Alton K. Cur- 
tis, M. D., Danforth; David Hunter, M. D., 
Vanceboro; and James W. Crane, M. D., 
Woodland. 

YORK COUNTY: Paul S. Hill, Jr., M. D., Bidde- 
ford-Saco; James H. MacDonald, M. D., 
Kennebunk; Gerald Smith, M. D., Ogunquit; 
William T. Elliott, M. D., North Berwick- 
South Berwick; Charles W. Kinghorn, M. D., 
Kittery; Stephen A. Cobb, M. D., Sanford- 
Springvale; Paul C. Marston, M. D., Cor- 
nish; and Arthur G. Wiley, M. D., Buxton. 


Figures compiled at headquarters show the scope of the service given through the Dr. 
Joseph W. Scannell Memorial Fund. Every county is represented by patients treated from 
May to October, 1938, when the fund became exhausted. Of the 194 needy cases treated, 86 
were men and 108 were women, with the following county distribution: Androscoggin, 28; 
Aroostook, 18; Cumberland, 35; Franklin, 1; Hancock, 14; Kennebec, 12; Knox, 6; Lincoln, 
1; Oxford, 6; Penobscot, 18; Piscataquis, 5; Sagadahoc, 5; Somerset, 9; Waldo, 15; Wash- 
ington, 8; and York, 13. 


As the 1939 campaign starts, the Women’s Field Army expresses again its appreciation 
for the cooperation of the Maine Medical Association in its two years of existence and looks for- 
ward to the same interest and help in this campaign and in the work of the coming year. 




Ten Golden Pules of the Can gei: 
Examination 

1. Examine the lips, tongue, cheeks, ton- 
sils, and pharynx for persistent ulcerations, 
the larynx for hoarseness and the lungs for 
persistent cough. 

2. Examine the skin of the face, body, and 
extremities for scaly, bleeding warts, black 
moles, and unhealed scars. 

3. Examine every woman’s breast for 
lumps or bleeding nipples. 

4. Examine the subcutaneous tissues for 
lumps on the arms, legs, or body. 

5. Investigate any symptoms of persistent 
indigestion or difficulty in swallowing. Pal- 
pate the abdomen. 


6. Examine the lymphode system for en- 
largement of the nodes of the neck, axilla, or 
groin. 

7. Examine the uterus for enlargement, 
lacerations, bleeding, or new growth. Make 
a bimanual examination to determine the 
condition of the ovaries. 

8. Examine the rectum and determine the 
cause of any bleeding or pain. 

9. Examine the urine microscopically for 
blood. 

10. Examine the bones and roentgeno- 
graph any bone which is the seat of a boring 
pain, worse at night. — Feank E. Adair, 
M. D., in Southern Medicine & Surgery , 
Aug., 1937. 


Volume Thirty, No. 3 


County News and Notes 


63 


County N eivs and Notes 


County Secretaries — 
Attention! 

The Committee on Graduate Education has pre- 
pared panel discussions which are now available 
for County Medical Society meetings. It is hoped 
that you will all make use of these programs. To 
do so please write directly to the Chairman. 

Pneumonia — F. T. Hill, M. D., Waterville, 
Chairman. 

Cardio-Vascular Disease — E. E. Holt, Jr., M. D., 
723 Congress Street, Portland, Chairman. 

Laboratory Procedures and Their Relation to 
Clinical Medicine — Julius Gottlieb, M. D., Lewis- 
ton, Chairman. 

The Acute Surgical Abdomen — Frank H. Jack- 
son, M. D., Houlton, Chairman. 

Fractures — Allan Woodcock, M. D., Bangor, 
Chairman. 


Androscoggin 

The regular meeting of the Androscoggin County 
Medical Society was held February 16, 1939, at 
the Auburn Y. M. C. A„ at 8.15 P. M. 

Minutes of the last meeting were read and 
approved. 

A report of the T. B. Association was given by 
Dr. Russell and was placed on tile. An expression 
of appreciation to the members of the Society ac- 
tive in this work was made and that the Medical 
Society should continue. 

The Committee investigating the telephone rates 
reported and a discussion followed. 

Following the business meeting very interest- 
ing papers on Caesarean Section were presented 
by Dr. Linwood Sweatt and Dr. L. C. Gross. A 
lively discussion followed. 

Meeting adjourned at 11.00 P. M. 

Respectfully submitted, 

W. P. Webber, Secretary. 


Cumberland 

Roger I. Lee, M. D., spoke on “The Doctor’s 
Dilemma, when and if the Government goes into 
the Practice of Medicine in a Big Way” (this 
paper appears elsewhere in this issue) at the 
Cumberland County Medical Society meeting held 
January 27, 1939, at the Eastland Hotel. 

The meeting was preceded by a clinic at the 
Maine General Hospital at 4.30 P. M., at which 
the following program was presented: 

Embryonic Carcinoma of Testicle — R. L. Hunt- 
ress, M. D. 

Sloughing of Legs — G. A. Tibbetts, M. D. 

Vaginal Hysterotomy— P. H. McCrum, M. D. 

Acute Pancreatitis — T. C. Bramhall, M. D. 

Two Cases of Severe Headache — J. R. Hamel, 
M. D. 

Chronic Supperative Otitis Media with Intra- 
cranial Involvement — C. H. Gordon, M. D. and 
H. E. MacDonald, M. D. 

Harold V. Bickmore, M. D., Secretary. 


Portland Medical Club 

The regular monthly meeting was held at the 
Columbia Hotel, Tuesday evening, January 3rd, 
at 8.15 P. M. Twenty-seven members and one 
guest were present. 

Dr. Albert D. Foster and Dr. Jack Spencer were 
elected to membership. 

Dr. Edward A. Greco gave an interesting paper 
on The Heart in Lung Diseases. The value of the 
talk was increased by the lantern slides and 
x-rays used to demonstrate important points. 

Alice Whittier, Secretary. 


The regular monthly meeting was held at the 
Columbia Hotel, Tuesday evening, February 7tli, 
at 8.15 P. M. The meeting was well attended, 
forty-three members and two guests being present. 

A symposium on The Diagnosis and Treatment 
of Joint Disease was conducted with the following 
members participating: 

Dr. T. A. Martin dealing with the shoulder joint. 

Dr. W. L. Casey dealing with the sacro-iliac 
joint. 

Dr. C. C. Corson dealing with the knee joint. 

Dr. H. W. Lamb dealing with the ankle joint. 

Dr. E. S. Hall dealing with the hip joint. 

Alice Whittier, Secretary. 


Kennebec 

A meeting of the Kennebec County Medical As- 
sociation was held at the Elmwood Hotel in Water- 
ville, Maine, Thursday, February 16, 1939, to which 
the members of the Franklin, Somerset and Waldo 
County Medical Associations were invited. 

Clinical Session was held at 5.00 P. M., which 
was presided over by Leon D. Herring, M. D., 
President. 

(1) Old Ruptured Gall-Eladder Found at Opera- 
tion — A. H. McQuillan, M. D. 

(2) A Case of Cholelithiasis — Harvey Bour- 
assa, M. D. 

( 3 ) Ruptured Gall-Eladder and Incarcerated 
Inguinal Hernia — EL H. Risley, M. D. 

( 4 ) Panophthalmitis As a Complication of Pneu- 
monia — V. C. Totman, M. D. 

(5) Olecranon Bursitis — E. M. Tower, M. D. 

( 6 ) Carcinoma of Larynx, Laryngectomy, Arti- 
ficial Larynx — F. T. Hill, M. D. 

(7) Caesarean Sect'on — W. H. Walters, M. D. 

(8) Plastic Operation for Deformity of Face 
Secondary to Operation for Carcinoma of Antrum 
— E. R. Irgens, M. D. 

(9) Laceration of Orbit — L. A. Guite, M. D. 

(10) Osteochondroma of the Frontal Sinus — 
T. C. McCoy, M. D. 

Dinner at 6.30 P. M. followed by a business meet- 
ing. The minutes of the last meeting were read 
and approved. 

Resolutions on the recent death of Ralph D. 
Simons, M. D„ of Gardiner, were read by A. B. 
Libby, M. D. Resolved that a copy of the resolu- 
tions be spread upon the records of the Kennebec 
County Medical Association, and that a copy be 
sent to the bereaved family. 


The Journal of the Maine Medical Association 


6U 


Scientific Session: 7.30 P. M. 

Panel Discussion — Pneumonia. 

Chairman, Frederick T. Hill, M. D., Waterville. 

History and Examination — Theodore E. Hardy, 
M. D. Waterville. 

Pathology and Laboratory Studies — Julius Gott- 
lieb, M. D., Lewiston. 

X-ray — Langdon Thaxter, M. D., Portland. 

Cardiac Complications — Eugene Drake, M. D., 
Portland. 

Surgical Complications — Stephen A. Cobb, M. D., 
Sanford. 

Medical Treatment — E. R. Blaisdell, M. D., Port- 
land. 

This discussion was under the auspices of the 
Committee on Graduate Education and was ably 
presented and brought out much valuable discus- 
sion. 

There were 55 members and guests present. 

Respectfully submitted, 

Frederick R. Carter, M. D., 

Secretary-Treasurer . 


Knox 

The scheduled meeting of the Knox County 
Medical Association was held at the Copper Ket- 
tle, Rockland, Maine, February 14th. The meeting 
was called to order by Dr. Howard Apollonio, 
President. The minutes of the last meeting were 
read and approved. A letter from Dr. Carter, Sec- 
retary of the State Association, in regard to re- 
ports asked for in the National Survey read. This 
program was discussed by Dr. Jameson and Dr. 
Ellingwood, who pleaded for completion of these 
records and stressed their importance. 

A letter from Dr. Carter concerning panel dis- 
cussions by the Comjmittee on Graduate Education 
was read. Dr. Torrey of Searsport extended an 
invitation to Belfast on March 23 to a joint meet- 
ing of three societies with the panel discussion on 
Fractures. 

A letter from the Red Cross thanked the Medical 
Society for assistance at a recent Diphtheria Toxoid 
Clinic at which 1,185 children were given immun- 
izing doses. The report shows what a great amount 
of work was done, and 80% of the total school en- 
rollment is a large percentage. 

Dr. Coombs of Augusta expressed the desire of 
the Health Department that a Schick test be made 
in six months in connection with the program for 
immunization. He also stressed the importance of 
examination for Scurvy, and explained the reason 
why French-Canadian families do not have it so 
frequently. 

After a flowery introduction, Dr. Everett D. 
Kiefer gave a very clear and concise talk, really 
worthwhile, on The Management of Ulcerative 
Colitis and Functional Colonic Disorders. 


This was discussed by Dr. Clapp of Lewiston. 
Drs. Laughlin, Soule, Curtis, Hutchins, Apollonio, 
Greene and Jameson, all asked pertinent questions, 
which were answered by Dr. Kiefer. Much interest 
and a very considerable knowledge of the subject 
was shown. 

The meeting was adjourned. 

A. J. Fuller, Secretary. 


Oxford 

A combined meeting of the Oxford County Medi- 
cal Society and the Bingham Associates was held 
Monday, January 23, 1939, at Rumford, Maine. 

Program 

At Rumford Community Hospital 

4.00 P. M. Clinic. Case discussed by Dr. S. J. 
Thannhauser, Boston, Massachusetts. 

5.30 P. M. Business meeting of the Oxford 
County Medical Society. 

At Hotel Harris 

6.30 P. M. Dinner. 

7.30 P. M. Lecture, Diseases of the Liver, by 
Dr. S. J. Thannhauser. 

There were twenty-four members and guests 
present. 

J. S. Sturtevant, M. D„ Secretary. 


Penobscot 

The regular meeting of the Penobscot County 
Medical Association was held Tuesday, February 
21st, at 7.00 P. M., at the Bangor House. 

The speaker of the evening was S. J. Thann- 
hauser, M. D., Assistant Director of the Joseph H. 
Pratt Diagnostic Hospital, at Boston, Massachu- 
setts. Dr. Thannhauser spoke on the subject: 
Liver Diseases. 

Joseph Memmelaar, M. D„ of Brewer, Norman 
W. Loud, M. D., of Bangor, and Herbert L. Taylor, 
M. D., of Dexter, were elected to membership. 

Forrest B. Ames, M. D., Secretary. 


New Members 

Penobscot 

Norman Wiley Loud, M. D., Bangor. 
Joseph Memmelaar, M. D., Brewer. 
Herbert Leiois Taylor, M. D., Dexter. 


Have You Paid Your 1939 State and County Dues? 

To insure being in the annual roster, which is to be printed in the May issue of the Journal, 
members must be reported in good standing by their County Secretary on or before April 1st. 


Volume Thirty , No. 3 


Necrology 


6 5 


Coming Meetings 


County Medical Societies 
Kennebec 

Kennebec County Medical Association, Frederick 
R. Carter, Augusta, Secretary. 

March 16, 1939, at the Augusta General Hospital. 
April 20, 1939, at the Gardiner General Hospital. 
Speaker: Samuel Levine, M. D., Boston. Subject: 
The Ausculation of the Heart. 

May 18, 1939, at the Veterans’ Administration at 
Togus, Maine. 


Knox 

Knox County Medical Association, A. J. Fuller, 
M. D., Pemaquid, Secretary. 

The next meeting of the Knox County Medical As- 
sociation will be held April 11th. Subject and 
speaker to be announced later. 


American Medical Association 

American Medical Association, St. Louis, 
May 15-19, 1939 


State Medical Associations 

Connecticut State Medical Society, New Haven, 
May 25-26. Creighton Barker, 258 Church 
Street, New Haven, Connecticut, Secretary. 

Maine Medical Association, Poland Springs, June 
25-26-27. Frederick R. Carter, 22 Arsenal 
Street, Portland, Maine, Secretary. 

New Hampshire Medical Society, Manchester, June 
8-9. C. R. Metcalf, 5 S. State Street, Concord, 
New Hampshire, Secretary. 

Massachusetts Medical Society, Worcester, June 

6- 7-8. Alexander S. Begg, 8 Fenway, Boston, 
Massachusetts, Secretary. 

Rhode Island Medical Society, Providence, June 

7- 8. Guy W. Wells, 124 Waterman Street, 
Providence, Rhode Island, Secretary. 

Vermont State Medical Society, Burlington, 1939. 
Benjamin F. Cook, 46 Nichols Street, Rutland, 
Vermont, Secretary. 


Necrology 


Frederick Augustus Bragdon, 
M. D., 1858-1939 

Doctor Frederick Augustus Bragdon, last of the 
community’s family doctors of the old school, died 
at his home, at Springvale, January 24, after an 
illness of three months. 

A practicing physician for more than 55 years, 
Dr. Bragdon was the son of the late George and 
Amanda Bragdon, born at Limington, October 24, 
1858. He received his early education in the 
schools of that town and at the age of 19 accepted 
a position as teacher in the public schools at Cor- 
nish, retaining the post for five years. It was 
while he was teaching in Cornish that he took his 
first steps in the field of medicine, studying with 
Dr. John T. Wedgewood in the periods he was 
able to spare from his school duties. Later he 
completed the medical course of the Maine Medical 
School of Bowdoin College, graduating with hon- 
ors in 1883. The following year he started prac- 
ticing in Shapleigh, where he met and married 
Miss Nellie Welch, then the district school teach- 
er, November 24, 1884. 

In 1886 and 1891, he completed post graduate 
medical courses in New York, being anxious to 
keep abreast of the newest developments in his 
chosen field. Then having conducted a practice in 
Shapleigh for about eight years, he located in 


Springvale where, except for a brief time spent in 
Lynn, Massachusetts, he resided and practiced up 
to the time of his death. 

Doctor Bragdon was an honorary member of 
the Maine Medical Association having received the 
Association’s Fifty Year Gold Medal at the 1933 
Annual Session of the Maine Medical Association 
held at Poland Springs. 

Other highlights in the career of Dr. Bragdon 
were his being honored by 10,000 people on the 
occasion of “Doc” Bragdon Day at Acton Fair last 
August and a testimonial dinner tendered him by 
fellow practitioners at the Henrietta D. Goodall 
Memorial Hospital, Sanford, on the occasion of his 
celebrating his 50th year in the profession. 

Dr. Bragdon had been one of the most promi- 
nent devotees of light harness racing in this sec- 
tion of Maine since 1898. He was long a familiar 
figure on ovals throughout Maine and on many 
New England tracks. 

Dr. Bragdon was a Past Master of Springvale 
Lodge, A. F. and A. M., a member of White Rose 
Chapter, Royal Arch Masons and Friendship 
Lodge of Odd Fellows. 

Surviving him are his wife, two sons, Fred R. 
of Wells and Harry B. of Berwyn, Illinois, two 
daughters, Mrs. Lena B. Ferguson of Ludlow, 
Massachusetts, and Mrs. Florence Morrison of 
Springvale, and several grandchildren. 


66 


The Journal of the Maine Medical Association 


Notices 


Notice of Child Health Day on May Day 

1939 

In accordance with the Congressional Resolution 
of May 18, 1928, which authorized the President to 
proclaim May Day as Child Health Day, the Chil- 
dren’s Bureau at the request of the State and Pro- 
vincial Health Authorities of North America are 
sponsoring Child Health Day Activities the 1st day 
of May this year. Through the pages of our State 
Association Journal the interest of our physicians 
in this program is solicited. Newspapers within 
our State and elsewhere have published statements 
concerning the nutrition of large numbers of chil- 
dren within our border which challenge not only 
our child welfare achievements hut also our ef- 
forts and accomplishments as practicing physi- 
cians. 

Is this not an appropriate time, then, for us to 
review the child health activities in our communi- 
ties and to support sound and well planned pro- 
grams for extension and improvement of them? 

The Health of the Child is the Power of 
the Nation 


Tumor Clinics * 

Portland: Maine General Hospital — Thursday, 

11.00 A. M.-12.00 M. Director, Mor- 
timer Warren, M. D. 

Lewiston: Central Maine General Hospital — 

Tuesday, 10.00 A. M.-12.00 M. Di- 
rector, E. V. Call, M. D. 

St. Mary's General Hospital — Wednes- 
day, 4.00 P. M. Director, R. A. Beli- 
veau, M. D. 

Waterville: Thayer Hospital — Thursday, 9.00- 

11.00 A. M. Director, Edicard H. 
Risley, M. D. 


Sisters' Hospital — Thursday, 9.00- 
11.00 A. M. Director, Blynn 0. 
Goodrich, M. D. 

Bangor: Eastern Maine General Hospital — 

Thursday, 11.00 A. M.-12.00 M. 
Director, Magnus F. Ridlon, M. D. 

* Approved by Maine Medical Association. 


American Association for the Study 
of Goiter 

The next annual meeting of the American Asso- 
ciation for the Study of Goiter will be held in 
Cincinnati, Ohio, May 22nd, 23rd and 24th. The 
program for this three-day meeting will consist of 
papers dealing with goiter and other diseases of 
the thyroid gland, dry clinics conducted by guests 
of the Association, and operative clinics in the 
various hospitals in Cincinnati. 

For further information write to the Corre- 
sponding Secretary, W. Blair Mosser, M. D., Kane, 
Pennsylvania. 


Philadelphia Academy of Surgery 
THE SAMUEL D. GROSS PRIZE 
Fifteen Hundred Dollars 
Essays will he received in competition -for the 
prize until January 1, 19^0 
The conditions annexed by the testator are that 
the prize “shall he awarded every five years to 
the writer of the best original essay, not exceed- 
ing one hundred and fifty printed pages, octavo, 
in length, illustrative of some subject in Surgical 
Pathology or Surgical Practice founded upon origi- 
nal investigations, the candidates for the prize to 
he American citizens.” 


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Bangor, Maine 
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INSURANCE 

Representing 

LOYALTY GROUP 


Phone 7723 




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may be suffering from any of the follow- 
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ments and those who should have a change 
of environment with a new incentive for 
getting well. Excellent food, pleasant 
surroundings, appropriate treatment. 


Dr. C. P. Wescott Sanatorium 
335 Brighton Avenue 
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Volume Thirty, No. 3 


Notices 


6 7 


It is expressly stipulated that the competitor 
who receives the prize shall publish his essay in 
book form, and that he shall deposit one copy of 
the work in the Samuel D. Gross Library of the 
Philadelphia Academy of Surgery, and that on the 
title page it shall be stated that to the essay was 
awarded the Samuel D. Gross Prize of the Phila- 
delphia Academy of Surgery. 

The essays, which must be written by a single 
author in the English language, should be sent 
to the “Trustees of the Samuel D. Gross Prize of 
the Philadelphia Academy of Surgery, care of the 
College of Physicians, 19 S. 22d St., Philadelphia,” 
on or before January 1, 1940. 

Each essay must be typewritten, distinguished 
by a motto, and accompanied by a sealed envelope 
bearing the same motto, containing the name and 
address of the writer. No envelope will be opened 
except that which accompanies the successful 
essay. 

The Committee will return the unsuccessful es- 
says if reclaimed by their respective writers, or 
their agents, within one year. 

The Committee reserves the right to make no 
award if the essays submitted are not considered 
worthy of the prize. 

Edward B. Hodge, M. D., 

Chari.es F. Mitchell, M. D., 
Calvin M. Smyth, Jr., M. D., 

Trustees. 

Philadelphia, February 1, 1939 


The Balkan Medical Union 

The Balkan Medical Union, in session at Istan- 
bul, for the 5th Medical Week, 

having taken into consideration the terrible 
sufferings which a total war will bring upon the 
civil population of open towns together with the 
total lack of any adequate means of protection, 
and having discovered that even in its restricted 
form the project of “sanitary towns” has not yet 
been adopted, and that all efforts made to pro- 
tect civilians against chemical warfare have till 
now remained as proposals only, and that even 
the protocol prohibiting the use of asphyxiating 
gas has not yet been ratified by all nations, 

has therefore decided to address itself to doc- 
tors of every nation with an appeal to take active 
measures and to fulfil this professional and hu- 
manitarian duty of awakening and stirring public 
opinion. 

The Balkan Medical Union believes that only 
enlightened international opinion can make plain 
the imminence of the danger and the proved use- 
lessness, even for the victor, of these terrible 
atrocities, and can thus lead to effective action. 
The immutable truth that 

hate breeds only hate, and atrocity breeds ven- 
geance must be impressed on everyone. 

Prof. Dr. Bensis, Dr. Scaramanga 
(Athenes), Dr. Zika Markovic, Prof. Dr. 
K. Sahovic, Dr. M. Simovic (Beograd), 
Prof. Dr. Giieorghiu, Dr. Popescu Bu- 
zeu (Bucarest), Prof. Dr. Akil Muhtar 
Ozden, Prof. Sedat Tavat, Prof. Dr. A. 
Suheyl Unver (Istanbul). 


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6 8 


The Journal of the Maine Medical Association 


IT’S HOOD’S 

FORM A21 5M 11-3-35-H 

H. P. HOOD & SONS— INSPECTION REPORT 


Station . Date 

Name of Producer. 

No. Cows Milking Lbs. Produced Daily. 


Temperature Water in Cooling Tank 


Is Ice Supply Adequate?. 


TOILET — Fly-proof 

STABLE 

Floors tight, smooth and clean 

Stable whitewashed every six months 

Proper ventilation 

Proper amount of light 

Sufficient bedding used 

Are cows clean 

Metal milking stools — hung up and clean 

Manure removed 50 feet from stable 

MILK HOUSE 

Adequate size 

Conveniently located 

Sheathed and painted inside 

Properly ventilated 

Screened 

Clean, smooth cement floor and drain 

Metal racks for cans, strainers, pails 

Insulated cooling tank 

EQUIPMENT 

Seamless covered pails used by all milkers . . 

Only disc type strainers used 

Cans and pails in good condition 

Is proper type sterilizer used 

Equipment stored in milk house 

SANITARY TECHNIQUE 

Udders wiped with damp cloth before milking 
Milkers’ hands washed before milking 

Milk strained in milk room 

Adequate provisions for hot water 

Equipment washed and sterilized after each milking 
Milk properly cooled 


Yes 

No 




























































Producer 

Inspector 


EVERY TWO WEEKS 

Each Local Farm is inspected by 
Hood's Country Control Staff and 
the above form filled out . 

Your Hood Milk is kept dean 
at the source . 

PORTLAND, 2-5491 

LEWISTON, 3830 RUMFORD, 239 


“ Doctor Bradley Remembers ” 

By Francis Brett Young. Published by Reynal 
& Hitchcock, New York, 1938. Price, $2.75. 

During the recent years a considerable number 
of good novels depicting the life or lives of the 
family physician have been written. The book un- 
der review tells the story of Dr. Bradley, a general 
practitioner of Sedgebury, Mr. Young’s beloved, 
smoked-grimed Black Country in England. It tells 
of the times when the long glowing spark of medi- 
cal heroism suddenly burst into flame and fired 
such men as Lister, Koch, Pasteur, Cushing, etc., 
with new enthusiasm and carried them to undying 
fame. 

In charming, easy flowing language, the reader 
is told of the various obstacles which John Bradley 
had to overcome, how, with all the expenditure of 
his energy, he could reach but mediocre success, 
how he was, from birth till death, destined to fight 
adversity almost always alone. Realizing his own 
shortcomings, he hoped that some day there would 
be a better doctor than he could be to succeed him 
and with special effort he tried to raise his son 
for the noble profession, quite contrary to the lat- 
ter’s own inclinations, however. 

Finally after having survived the various shocks 
that fate dealt him, he, having tried to find for- 
getfulness by working harder among the poor, de- 
cides to sell his practice. Bent over his well kept 
daybook one evening, having written “paid” after 
the last entry, he fell into a state of reminiscent 
meditation. A rich life it was, full of hard work, 
some happy moments, many sorrowful years. In- 
wardly he is satisfied in the feeling that he had 
always done what he thought to be right, now 
after fifty years of practice, he suddenly discovers, 
that although his book was well filled with entries 
and in final order, he knew not how long his aging- 
aching body could survive on his exceedingly 
small saved up reserve fund. 

Though physically tired, his spirit was now 
wide awake. With lightning rapidity it carried 
him through most of his seventy odd years. Mr. 
Young, himself a physician I am told, catches Dr. 
Bradley’s every, thought and presents it in a true- 
to-life manner that appeals to every adversity bat- 
tling life asserting soul. In Dr. Bradley Remem- 
bers, Francis Brett Young seems to be at his best. 


“What’s Wrong With Me” 

By H. Ameroy Hartwell, M. D., Fellow of the 
American Medical Association; Fellow of the New 
York Academy of Medicine; Member of the Medi- 
cal Society of New Jersey, The Hudson County 
Medical Society, The North Hudson Physicians’ 
Society, The W. H. Lucket Clinical Society, The 
American Heart Association, etc. 

Published by the County Life Press, Garden 
City, N. Y., 1938. 

The purpose of this book, written expressly for 
the general public, is to provide the reader with a 
simplified terminology of the symptomatology of 
a great variety of diseases. The author believes 
that by the encouragement of self-analysis the pa- 
tient will become conversant with terms roughly 
describing his complaints SO' that he may intelli- 
gently present his case to his physician. The ma- 
terial is alphabetically arranged. The general de- 
scription of the characteristics, symptoms and 
causes of each disease take up about one page. 288 
diseases are described. 

The author believes that, “If you have the symp- 
toms enumerated in five or more lines under any 
of these diseases, you may conclude that you are 
probably suffering from that disease; but verify 
your opinion by consulting your physician in time 
to establish a correct diagnosis by his physical 
findings.” 



The Journal 


of the 

Maine Medical Association 


Uolume Thirty Portland, Ulaine, April, 1939 


No. 4 


Communicable Disease Hospitals * 

By I). L. Rictiaedson, M. D., Superintendent Charles A". Chapin Hospital, Providence, 

Rhode Island. 


The evolution of the hospital for infectious 
diseases has paralleled the acquisition of 
knowledge concerning infectious diseases, 
their modes of transmission, the occurrence 
of extensive epidemics of certain highly 
transmissible diseases, and both the intel- 
lectual and financial progress in different 
countries. It should also be emphasized in 
the beginning that institutions for the segre- 
gation of contagious diseases could hardly, 
with few exceptions, be called hospitals un- 
less they have been built within the last fifty 
or seventy-five years, and that even primitive 
places of isolation date no further back than 
the fifteenth century. 

During the Middle Ages, Europe was 
overrun with leprosy. This disease, long be- 
fore this period, was recognized as a contact 
disease and an effort was made in different 
European countries, particularly in France, 
to segregate lepers in isolation hospitals 
called lazarettos. This name for isolation 
hospitals still survives in some Latin coun- 
tries. Some 2,000 institutions for their 
segregation were erected of which 1,500 were 


located in France. Since the diagnosis of 
leprosy was not always accurate, cases of 
syphilis and other skin diseases were often 
included. Leprosy subsequently began to dis- 
appear either because of isolation of cases or 
due to some change in the virulence or in- 
vasiveness of the disease. In reading the his- 
tory of this period, it seems that the isolation 
of lepers should be given chief credit because 
the disease disappeared from Europe except 
for occasional cases in Norway and in coun- 
tries bordering on Asia, whereas it still per- 
sists in Asia and other eastern countries 
where isolation of lepers was not carried out 
or only to a very limited extent. 

The destructive wave of plague through 
Europe in the fifteenth century was another 
occasion when temporary quarters for isola- 
tion of cases w T ere erected in different Euro- 
pean countries. At other periods, epidemics 
of typhus fever, cholera, and smallpox com- 
pelled the building of isolation hospitals. 

Out of these experiences, the more pro- 
gressive countries in Eastern Europe began 
the erection of more permanent isolation hos- 


* Read before the Fall Clinical Session of the Maine Medical Association, at Lewiston, November 
3 , 1938 . 


70 


The Journal of the Maine Medical Association 


pitals. Among the earliest of these institu- 
tions was the London Smallpox Hospital es- 
tablished in 1745, the Lock Hospital for 
venereal diseases in 1746, and the London 
Fever Hospital in 1802. All these institu- 
tions were founded by private effort, not so 
much with the idea of controlling the disease 
as for providing the afflicted persons with 
adequate medical and nursing care. In fact, 
the first Public Health Act of 1848 contained 
no provision to allow the local boards of 
health to provide hospitals for infectious dis- 
eases. Such a provision was passed in 1866. 
Even at that time, knowledge about how in- 
fectious diseases were transmitted was quite 
vague. The early sanitary reformers were 
inclined to look for their origin in foul air, 
soil and water supplies rather than person to 
person infection. 

Strange as it may seem, about this time 
there was considerable difference of opinion 
relative to the advantage of caring for con- 
tagious patients in fever hospitals or of dis- 
tributing cases in the wards of a general hos- 
pital. In both England and France, it was a 
fairly general practice to admit a limited 
number of contagious patients to general hos- 
pitals. There was a feeling that it was safer 
for patients, nurses, and the other hospital 
officials not to concentrate too many patients 
in one hospital because of the danger of “con- 
centrating” the poison. Out of this contro- 
versy developed a new interest in infectious 
diseases and this was given further impetus 
in England by investigations of conditions in 
the Poor Law Infirmaries and the outbreak 
of a very severe type of scarlet fever in the 
early sixties. On the one hand were physi- 
cians who thought it was a crime to establish 
special isolation hospitals while on the other 
a more progressive group, who made careful 
studies, defended such hospitals. 

The outcome of this controversy was that 
in the early seventies, an extensive program 
of construction of isolation hospitals in Lon- 
don and other English cities was established 
with the idea that if all cases of these trans- 
missible diseases could be taken out of the 
community, diseases like scarlet fever and 
diphtheria could be eradicated. In this lat- 
ter respect, they were wrong but the hospitals 
did provide much better care for those who 
were ill with infectious diseases and such iso- 


lation did help to control epidemics even 
though it did not eradicate them entirely. 

All this took place before any disease-pro- 
ducing germs had been discovered. In the 
light of our present knowledge, the establish- 
ment of infectious disease hospitals was a 
decided forward step. As the bacterial causes 
of different infectious diseases were discov- 
ered during the last quarter of the nineteenth 
century, control of these diseases could be 
planned from exact knowledge as facts be- 
came available. Pasteur, Koch, Loeffler and 
other bacteriologists by their discoveries 
opened up a new era in public health and the 
administration of contagious disease hos- 
pitals. 

Even after the cause of some of the infec- 
tious diseases was discovered, the idea that 
they were disseminated through the air per- 
sisted. There was some justification for such 
a belief because disease-producing germs 
could be recovered not only from the patient, 
the ward furniture, floors and elsewhere, but 
also from the air. All kinds of bacteria 
could be grown on media plates exposed to 
the air in contagious disease hospitals. It 
is not to be wondered at that isolation hos- 
pitals constructed late in the last century and 
in the early years of the present century were 
of the pavilion type of construction with only 
one disease being cared for in the same build- 
ing or in a single ward. Whenever the build- 
ings were more than one story high, care was 
taken to provide separate entrances for each 
floor and to avoid the installation of ventilat- 
ing and heating ducts which opened into both 
wards. 

It does seem rather strange, however, that 
the transition from the antiseptic to the era 
of asepsis did not make more of an impres- 
sion on those conducting isolation hospitals. 
Surgeons soon learned that antiseptic sprays 
were unnecessary and that the bacteria in 
the air were usually saprophytes and that 
disease-producing organisms were compara- 
tively few in number. 

The credit for demonstrating that atmos- 
pheric transmission of infectious diseases 
was of little consequence in the hospitaliza- 
tion of infectious diseases should go to 
Grancher of Paris, visiting physician to the 
Hospital for Sick Children. This was a gen- 
eral hospital for the care of children. The 


Volume Thirty , No. U 


Commuricable Disease Hospitals 


71 


wards generally were large and contained 
patients who were ill with many kinds of 
diseases. On the Continent as well as in Eng- 
land, some general hospitals at the time ad- 
mitted a limited number of acute transmissi- 
ble diseases. About 1890, Grancher began 
to admit to these general wards, cases of scar- 
let fever, diphtheria, and measles. He iso- 
lated such patients in the ward by surround- 
ing the bed with screens, providing gowns 
and nursing utensils within the screened 
area, and required that the nurse and doctor 
should remove the gown and scrub hands be- 
fore leaving the enclosure. All utensils used 
in the enclosure were sterilized after being 
removed. An antiseptic solution was used on 
the hands. For a period of about ten years 
he kept up this administration experiment 
and concluded that scarlet fever and diph- 
theria were scarcely ever carried through the 
air and that even measles infection was rare- 
ly disseminated in this manner. 

About 1895, Roux, health officer of Paris, 
recognized the significance of these practical 
experiments and through his efforts the Pas- 
teur Hospital was completed in 1900. This 
was the first hospital in the world to be con- 
structed for the care of different infectious 
diseases on the same floor. Each ward floor 
consisted of single rooms and a large room 
divided into four compartments by partitions 
six or seven feet high for the care of conva- 
lescents. Each room was provided with a 
lavatory and sink for the convenience of the 
nnrses in carrying out the technique. Pa- 
tients were confined to their rooms and the 
aseptic technique was rigidly carried out to 
prevent disease-producing germs from being 
transmitted from one patient to another. A 
concession to previous ideas was made by the 
construction of narrow balconies along the 
outside of the building at each floor level and 
doors were located to allow entrance and exit 
from each room to these balconies. The meth- 
od of transmission of typhus and some other 
diseases had not been discovered and the 
provision of the balconies and doors made it 
possible to close the corridor doors so the 
nursing service could be carried out through 
balcony entrances. Actually, this practice 
was never employed and the balconies have 
been used to allow visitors to view the pa- 
tients in their rooms. 


Since this hospital was opened, the inci- 
dence of cross-infection has been very low, a 
fraction of one percent. All kinds of infec- 
tious diseases, including smallpox have been 
cared for simultaneously in these wards. The 
actual experience in the wards of the Pasteur 
Hospital proved conclusively that contact dis- 
eases are not, except in rare instances, trans- 
mitted through the atmosphere. 

Soon after the opening of the Pasteur Hos- 
pital, some of the London fever hospitals cau- 
tiously began to introduce aseptic nursing. 
The English contagious disease hospitals of 
that day cared for patients, for the most part, 
in large wards. Some of these were cut up 
into cubicles with seven-feet high partitions 
between rooms and between rooms and corri- 
dor. Considerable trouble had been experi- 
enced with return cases of scarlet fever and 
these cubicles were first utilized for the isola- 
tion of cases for 48 hours before discharge. 
Subsequently these cubicle wards were used 
for the isolation of miscellaneous diseases. 
The results were similar to those reported 
from Paris and since that early experience, 
older contagious hospitals have been recon- 
structed and new ones built to make it pos- 
sible to care for different diseases on the 
same floor and equipped to make the nursing 
technique as simple as possible. 

The earliest contagious hospitals in this 
country were built for the care of smallpox 
and were called pest houses. These wooden 
structures which were widely distributed for 
smallpox had been quite common from 
early colonial days. These were used only 
when the disease was prevalent. They could 
hardly be called hospitals. Usually some 
dwelling outside the town was purchasd for 
the purpose and when the disease appeared, 
the temporary employees were recruited to 
care for the patients. 

Snbsequently the larger cities built perma- 
nent hospitals for the care of scarlet fever 
and diphtheria and other diseases were ac- 
cepted to a limited extent. Following the 
practice in Europe, these hospitals were of 
the pavilion type for the most part, each pa- 
vilion designed for a single disease. In most 
of the earlier hospitals of this type, the med- 
ical and nursing service and the hospital 
equipment was inferior to that supplied by 
the contemporary general hospitals. Even 


72 


The Journal of the Maine Medical Association 


up to quite recently, an isolation hospital has 
been looked upon as a place of segregation. 
Little thought or interest was shown in pro- 
viding good medical and nursing care. The 
public was not interested in what happened 
to the patient as long as he was removed from 
the community. 

In 1910, the Providence City Hospital, 
now known as the Charles V. Chapin Hos- 
pital, was completed and here it was that 
aseptic nursing was first tried out in this 
country. One ward was used for scarlet fever 
and one for diphtheria patients while others 
were used for miscellaneous diseases. A very 
exacting technique was planned and carried 
out. Essentially the technique is the same 
now as that employed in 1910 although it 
has been simplified considerably. How the 
wards are almost all for miscellaneous 
diseases, with the exception of scarlet fever, 
there are not enough patients suffering from 
one disease, except during epidemics, to keep 
one ward busy. 

A very careful record has been kept of 
cross-infections for twenty-eight years. These 
have always been recorded in the annual re- 
port. The cross-infection rate has been varia- 
ble. It has exceeded two percent in six of 
the twenty-eight years and for several years 
it has been about one-half of one percent. 

When the writer first began to read papers 
about aseptic nursing, the older superinten- 
dents were very courteous but very incredu- 
lous. Such a method could never succeed in 
their estimation. Success was attained and 
the isolation of miscellaneous diseases on the 
same ward floor by following rules of asepsis 
has been generally accepted in this country. 

When cross-infections do occur, they are 
almost always cases of chickenpox and mea- 
sles. These are the only two diseases which 
require special consideration except that 
whenever smallpox is admitted, all patients 
on the ward are revaccinated. 

Since it has been demonstrated that air 
transmission of infectious diseases is of little 
consequence, the modern infectious disease 
hospital is quite different from the old con- 
tagious hospital. It is usually built of brick 
and more than likely is stories in height except 
in the smaller cities and towns. If there are 
enough patients suffering from scarlet fever, 
for instance, then one or more wards are re- 


served for that disease. When outbreaks of 
measles or acute poliomyelitis occur, the 
cases are concentrated in separate wards to 
facilitate treatment and nursing care. Other 
wards are reserved for miscellaneous dis- 
eases. All wards, however, should be so con- 
structed that no more than six patients are 
cared for in a single room. In larger hospi- 
tals, old wards of greater capacity are divid- 
ed into cubicles or beds, are separated far 
enough apart to keep patients from direct 
contact and these are particularly useful for 
infants and small children. It is essential to 
make it impossible for patients suffering 
from different diseases to come in direct con- 
tact and the number of patients in each unit 
should be few so that if a cross-infection does 
take place, secondary cases will be limited. 

It is extremely important that the physi- 
cians in charge of infectious disease wards 
shall have experience in diagnosis so that 
only patients suffering from the same disease 
will be put in the same unit. Cases with a 
doubtful diagnosis should always be put in a 
separate unit until a diagnosis can be made. 
Resident physicians should follow the pa- 
tients very carefully in order to detect at the 
earliest possible moment the onset of a sec- 
ond disease or some infectious complication. 

The nursing procedure may at first glance 
seem to be complicated but the principle un- 
derlying each procedure is much like the 
technique observed in the operating room. 
Infection is confined to the rooms occupied 
by the patients. Everything which is taken 
from the room must be properly cleaned or 
sterilized. The hands of the physicians and 
nurses must be scrubbed for at least two min- 
utes with soap and water. It is seldom neces- 
sary to use a disinfectant. Gowns are worn 
if an examination or nursing procedure is of 
such a nature that clothing might come in 
contact with the patient or anything in the 
room. Each room should contain a lavatory 
where the water can be turned on by forearm 
or elbow, knee or foot, and the hands should 
be scrubbed in running water of suitable 
temperature. 

The kitchen and service room should be 
equipped with utensil sterilizers and clothes 
chutes for used linen so that it will not be 
left on the ward between collections. Infec- 
tious diseases are usually transmitted by 


Volume Thirty, No. 4 


Communicable Disease Hospitals 


73 


direct contact or indirect contact when hands 
or nursing- utensils are contaminated with 
fresh secretions. For this reason, the nursing 
technique should be rigidly carried out and 
to make it uniform throughout the hospital, 
all procedures should be in printed form and 
supplied to all physicians and nurses. 

Certain precautions should be observed in 
the disposal of used linen, the supplying of 
the wards with food and drink, and other 
contact of the service portions of the hospital 
and the wards. The danger from such in- 
direct contact, however, is very slight and the 
technique involved is very simple. It is im- 
portant that the hospital personnel be under 
careful observation to detect the onset of in- 
fectious diseases at the earliest possible mo- 
ment. Otherwise they might distribute the 
infection to other members of the hospital 
staff and to patients if they are on duty when 
in an infectious state. All these precautions, 
in a general way, are carried out in all mod- 
ern infectious disease hospitals and by their 
faithful execution, the danger of secondary 
diseases occurring among patients and hos- 
pital personnel is slight. 

Since it is feasible to care for different 
transmissible diseases not only in the same 
building but also on the same floor, it makes 
it possible for even the smaller cities and 
towns to provide isolation hospitals. Previous- 
ly, even in the larger cities, isolation hospi- 
tals found the number of patients so reduced 
seasonally that a large part of the hospital 
capacity was unoccupied, even though the 
employees had to be kept on the payroll. This 
also made the expense, particularly the per 
capita expense, very high. 

Another change has been noted. Formerly 
contagious hospitals limited their admissions 
to scarlet fever, diphtheria, and smallpox. 
From the beginning, the Chapin Hospital 
accepted for treatment any kind of trans- 
missible disease including typhoid fever, 
pneumonia, poliomyelitis, epidemic menin- 
gitis, erysipelas, and other diseases which 
were then admitted to general hospitals. 
Gradually general hospitals have been turn- 
ing these cases over to the isolation hospitals. 
This change has taken place quite generally 
over the country. The general hospitals feel 
that they are not properly equipped or staffed 


to take a chance with transmissible diseases 
unless it is absolutely necessary. 

To correct the poor service in isolation 
hospitals and to reduce the expense, in 
1029 a resolution was passed by both the 
American Hospital Association and the 
American Public Health Association to the 
effect that in cities of less than 100,000 pop- 
ulation, the local isolation hospital should be 
located on the grounds of a general hospital. 
This resolution could not have been passed 
years ago because of the fear of air infection 
and imperfect administration of the isolation 
units. The reasons advanced for this resolu- 
tion were that it would be cheaper, that the 
patients in the isolation wards would have 
the benefit of the services of specialists, bet- 
ter hospital facilities such as X-ray, labora- 
tory and operating facilities, and other serv- 
ices so lacking in the older isolation wards. 
Moreover, such wards would be of great serv- 
ice for the isolation of many kinds of infec- 
tions which are constantly arising in any 
general hospital. These wards would be in- 
valuable for the training of internes and stu- 
dent nurses. 

As a matter of fact, every general hospital 
should have a few rooms or a ward, depend- 
ing on its size, for the isolation of transmis- 
sible diseases. These rooms should be for a 
single patient and each room should have a 
lavatory and the ward should be provided 
with utensil and dish sterilizers so that asep- 
tic nursing can be easily carried out. Such 
an investment will help to prevent infections 
which not infrequently occur in general hos- 
pitals and especially hospitals for children. 

If the general hospital in an}'- city or town 
is a private hospital, as is usually the case, 
the city can pay for this service at much less 
expense than to maintain a separate hospital. 
The larger cities can well afford to build and 
maintain isolation hospitals which are as 
well equipped and well staffed as modern 
general hospitals and there are many of these 
now in existence. By the arrangement al- 
ready described, it is possible for smaller 
cities and even rural districts, because of the 
automobile and good roads, to be equally well 
served. 

Thirty years or more ago, to serve in an 
isolation hospital necessitated almost com- 


The Journal of the Maine Medical Association 


74 


plete isolation from tlie community. Nurses 
and employees, and sometimes even resident 
physicians lived in the patients’ pavilions. 
When they were allowed to leave the hospi- 
tal, it was only after bathing and donning a 
complete change of clothing. From the be- 
ginning at our hospital, physicians, nurses 
and employees have lived under the same 
conditions as those employed in general hos- 
pitals and this is generally practised in this 
country. 

Thirty years ago, with a few exceptions, 
student nurses never received training in con- 
tagious wards. The training schools, largely 
because of objections from parents of student 
nurses, would not allow affiliation with isola- 
tion hospitals. As a matter of fact, there 
was considerable justification for this atti- 
tude because illness among internes and 
nurses was very common and not infre- 
quently very serious. When aseptic nursing 
was introduced, the amount of illness de- 
creased remarkably. 

At the Chapin Hospital last year, where 
about 350 student nurses served a three- 
month training period, three contracted scar- 
let fever, one rubella, and one chickenpox. 
These were the only cases of infection con- 
tracted among the entire personnel. Internes 
scarcely ever contracted infection from pa- 
tients. On the average there has been only 
about one case a year among physicians and 
sometimes several years may elapse without 
any infections. Of course, there always is 
such a possibility in spite of all precautions 
but such infections are so infrequent that 
there is no longer any real fear of serving in 
an isolation hospital. 

Reference should be made to the work of 
Dr. and Mr. Wells at the Harvard School 
of Public Health. They have been working 
with ultra-violet light to kill bacteria in the 
air. They have developed a new suction ap- 
paratus for collecting organisms from the 
air. It has been found that exposure to ultra- 
violet rays will kill bacteria in the at- 
mosphere. These lights have already been 
installed in some operating rooms and ex- 
perimentally in two or three hospitals. 

Some disease-producing bacteria can be re- 
covered from the air. This is not a new 
scientific fact. However, even if thev can be 


recovered, this is no indication that they are 
really a source of infection except rarely. 
Actual experience in operating rooms and 
hospitals over a period of many years clearly 
demonstrates that infections from the air are 
rare. The use of these lights revives the belief 
in atmospheric transmission and especially in 
infectious disease hospitals it is likely to 
undermine the quality of aseptic technique 
for contact, after all, is practically the only 
way that disease-producing bacteria are 
transmitted. 

So far there has been no available statis- 
tical data to show that the introduction of 
ultra-violet light has reduced the incidence 
of operating room infections or cross-infec- 
tions in the wards of isolation hospitals. Dur- 
ing this year just closed, there was only one 
case of cross-infection, a case of chickenpox, 
at our hospital. This is the lowest rate that 
we have ever had. Had we employed ultra- 
violet lights in the wards we probably would 
give them some credit. They are expensive 
to buy and expensive to maintain, and they 
offer some administrative difficulties. While 
we have not tried them, I am quite sure from 
many years of experience with contagious 
diseases that they have little to recommend 
them. 

Hospitalization of acute transmissible dis- 
eases will not stamp them out. There are as 
many cases of scarlet fever and diphtheria 
in London as there were fifty years ago. 
These diseases are milder and much better 
cared for, lives are saved, and isolation has a 
steadying effect on outbreaks. The expense 
necessary for the best of medical and nursing 
care of acute infectious diseases, particularly 
the more serious ones, is more than justified 
from the standpoint of life-saving alone to 
say nothing of the welfare of the individual 
patient and the community. 

The past fifty years may well be called the 
Golden Era of Medical Progress. It has been 
a great privilege to have lived during this 
period and to have observed and taken even 
a small part in what has been accomplished. 
Not the least of this great improvement has 
been the introduction of more scientific meas- 
ures for the control and treatment of acute 
infectious diseases. 


Volume Thirty, No. U 


Syphilitic Epilepsies 


75 


Syphilitic Epilepsies (Their Frequency and Treatment)* 

By L. Babalian, M. D., Portland, Maine 


Since the works of Fournier, written over 
half a century ago, the syphilitic nature of 
some cases of epilepsy is no longer doubted. 
Syphilis is responsible for some cases of in- 
fantile epilepsy, so-called idiopathic. Syphi- 
lis can, in adults as well as children, create 
all forms of epilepsy : 

(a) major attack of haut-mal with gener- 
alized convulsions and with or without the 
initial cry ; — 

(b) slight attack of petit-mal, such as ab- 
sences, jerking, dizziness, fainting; — 

(c) partial attack; so-called Bravais- 
Jacksonian, either intermittent, or becoming 
generalized, or continuous, and leaving after 
effects of slight paralysis ; — 

(d) epileptic equivalents; either psychic 
paroxysms such as ambulatory automatism, 
or sensorial equivalents (hallucinations of 
taste, smell, etc.), or visceral equivalents 
(migraine, nausea, enuresis, etc.). 

These are well-known facts, and no patho- 
logical treatise exists which does not mention 
them more or less fully. 

Besides these different forms of epilepsy 
syphilis can also be the cause of epileptiform 
troubles, such as laryngeal ictus of locomotor 
ataxia, such as the compressive troubles due 
to cerebral gumma or to osteo-periostitis of 
the inner table of the skull. 

I only mention these manifestations wish- 
ing to call attention to certain points. 
*********** 

Since Fournier authors have faithfully re- 
produced the picture he drew of syphilitic 
epilepsy. As he did, they also insist on cer- 
tain clinical details which would stamp the 
luetic origin of these symptomatic epilepsies. 
These would differ from true epilepsy, so- 
called idiopathic, by their later appearance, 
their resistance to the nervine medications, 
their ending sooner in insanity. All these 
distinctions are debatable, and mean nothing, 
because syphilis can be the cause of all clini- 
cal types. 


Syphilitic epilepsy besides can be associ- 
ated with other manifestations of cerebral 
syphilis : cephalaea, cranial paralysis, tabes 
dorsalis, general paresis. But it is evident 
that one must not wait for these manifesta- 
tions before diagnosing epilepsy as syphilitic. 

To summarize, syphilitic epilepsy has no 
clinical character which belongs only to it, 
and cannot he differentiated from so-called 
idiopathic epilepsy, an entity which is more- 
over in doubt. 

*********** 

A point on which controversy rages among 
authors is the frequency of syphilitic epilep- 
sy. Fournier thinks that when it is not a 
question of idiopathic epilepsy, eight times 
out of ten, it is luetic. Gougerot goes even 
further ; according to him syphilis is respon- 
sible for a great many cases of idiopathic 
epilepsy. As a general rule syphilitic epilep- 
sy is considered rare ; it is found in seven 
percent (Viet) or five percent (Bratz and 
Luth) of cases. According to Stokes, the pro- 
portion of syphilis in epilepsy varies a great 
deal with the date of its appearance ; in the 
adult types from two to three percent have 
positive blood Wassermann, while in chil- 
dren twenty percent. 

If the role of syphilis is generally unesti- 
mated in epilepsy, that is because of three 
reasons : 

First, in nervous syphilis dystrophic stig- 
mata (osseous, dental, etc.) are rare and 
often absent. Their absence is even so fre- 
quent that some authors raise the question 
of whether the virus of nervous syphilis is 
the same as that of dystrophic syphilis. 

Secondly, specific treatment is usually 
without effect because, when epilepsy is clini- 
cally apparent, that is the result of a neurog- 
liac sclerosis which is a definite and irre- 
parable lesion. The therapeutic test is here 
without value. 

Finally, a negative serology in blood is 
extremely common in congenital syphilitics; 
that is a well-known fact and does not mili- 


* Presented at the Staff Meeting of the Maine Eye and Ear Infirmary on December 15, 1938. 


7 6 


The Journal of the Maine Medical Association 


Conclusions 


tate against syphilis in epileptic children. 
The examination of the cerebrospinal fluid 
gives perhaps truer information. However, 
it is not rare to find a cerebrospinal fluid nor- 
mal in old stationary nervous syphilis. Even 
in recent cases, if the lesion is sub-cortical 
and therefore at a distance from the menin- 
ges, as it is often the case in idiopathic epil- 
epsy, the cerebrospinal fluid can be found 
normal. 

To establish the syphilitic nature of an 
epilepsy, nothing remains to do in several 
cases but a minute inquiry into the family 
history. To prove this point take for example 
the case that Dr. B. B. Foster and I observed 
recently. 

G. S. Boy 8 years old. Born at term with- 
out forceps. At about two years appeared 
convulsions which recurred during several 
months and gradually gave place to true epi- 
leptic seizures. He was examined several 
times for syphilis, but this was not recog- 
nized because of negative Kahn. For six 
years the disease was considered an idio- 
pathic epilepsy with seizures once or twice a 
week in spite of phenobarbital and bromides. 
Each seizure lasts from one to four hours, 
some of them so serious as to necessitate pro- 
longed inhalations of chloroform. In addi- 
tion, during the past year, modification of 
disposition ; the child is more and more stub- 
born, cannot concentrate, remains in a state 
of complete ignorance and sometimes utters 
inarticulate cries. 

Finally there appears an intersitial kera- 
titis ; the child is then sent to Dr. E. E. Holt, 
Jr., who demands, with good reason, further 
examination from the standpoint of syphilis. 
This new examination reveals no character- 
istic stigmata and nothing in the blood. But 
an interview with the mother brings to light 
some interesting facts. She has had before 
this child, three other children all of whom 
died in infancy. After a long interrogation 
she admits having had before her marriage a 
chancre on the upper lip for which she had 
been given only four intravenous injections. 
Moreover, her blood is found strongly posi- 
tive. 

There is no longer any doubt that this case 
of so-called idiopathic epilepsy is in reality 
a clear case of luetic epilepsy, in spite of the 
absence of stigmata and negative blood tests. 


Syphilitic epilepsy is not as rare as the 
majority of authors would have us believe. 
Hereditary lues seems to be a frequent cause 
and should be sought by every kind of exam- 
ination, especially by a complete family in- 
quiry. 

There are, however, many cases where no 
traces of syphilis can be discovered; but 
there again it must not be ignored systemati- 
cally. If one considers the dark future of 
many epileptics, one lias the right to try a 
specific treatment in all these cases, because 
it is better there to sin by commission than 
by omission. But specific treatment can only 
have effect in being given at the outset of 
the disease, before the appearance of neuro- 
gliac sclerosis. One must then treat epilepsy, 
not when it is evident clinically, but in its 
prodromic stage. This stage, in child epilep- 
sy, is precisely that of the first convulsions 
in infancy, after which the convulsions cease 
and are followed generally by a period of de- 
ceiving calm. And it is only after several 
months or even years that appear the first 
signs of epilepsy. At that time it is too late 
to treat. The ideal way would be therefore 
to give a specific treatment as soon as the 
convulsions of infancy occur. I don’t mean 
that specific treatment should be given in all 
cases of convulsions. We must eliminate the 
cases due to obstetrical cranial injuries, and 
those more numerous and generally with 
fever, where convulsions are connected with 
toxi-infectious diseases. There remains a cer- 
tain number of cases where the nature of con- 
vulsions cannot be determined exactly. In 
these cases one has the right to and should 
give specific treatment. 

The problem takes a different form when 
epilepsy has become evident due to an irre- 
parable lesion. Specific treatment should, 
however, be tried, less with the hope to im- 
prove the disease than to limit the damages. 
In that case it seems prudent to use only 
bismuth or mercury ; because arsenic, strong 
vaso-dilatator, could favor the appearance of 
epileptic seizures, or even congestive and 
hemorrhagic lesions in the central nervous 
system, lesions which epilepsy already tends 
to produce. 


Volume Thirty , No. U 


May Day as a Child Health Day 


77 


May Day as a Child Health Day 

By Robert E. Jewett, M. D., Chairman State May Day Committee 


We are indebted to the barbaric Celts, who 
inhabited the British Isles two thousand 
years ago, for two time-honored traditions, 
Mistletoe and May Day. Mistletoe was a 
ceremonial object which captured the imagi- 
nation of that primitive Aryan people, be- 
cause it had no roots in the polluted earth 
and grew magically, high up in the branches 
of the oak tree, suspended between heaven 
and earth. Cut down with a golden sickle in 
the hand of a priestly Druid, it was used to 
make potions for the fertilization of barren 
women and cattle. 

The May Day of the Celts was heralded 
as the first day of spring, and the people led 
by the Druids celebrated it in wild, if cere- 
monial, revelry to stimulate the magic fruc- 
tification of the land. Nothing was more 
wonderful to those barbaric tribes than the 
magic appearance of buds upon the trees 
and the bursting forth of fresh green shoots 
from the dormant earth. Equally as im- 
portant, and far more wonderful, was the 
propagation of their flocks and herds. The 
fundamental nature of procreation remains a 
mystery, even to modern scientists ; so that 
it is small wonder that primitive peoples be- 
held it with religious awe. 

Two thousand years have passed, and great 
changes in the customs and traditions of the 
races of man have come about, since the 
Celts celebrated the first day of Spring, at 
places like Stonehenge, in England. The rise 
of Christianity was most important in 
bringing about these changes, and May Day 
came to be celebrated in a spirit of whole- 
some joy at the passing of winter, and the 
beginning of spring, even as the wild revel- 
ries of the Saturnalia were forsaken for a 
day of reverent observance of the birth of the 
Christ by peoples around the Mediterranean. 

As a festival characterized bv may-pole 
dances, and the distribution of flowers by 
throngs of happy children, May Day has 
been a long and pleasant tradition among 
English-speaking people. For generations its 
connotation has been one with new green 
grass, blooming flowers, and the happy laugh- 


ter of children, joyous at the new life being 
unfolded before them. 

However, if May Day did become a tradi- 
tion of beautiful and wholesome import, 
there remained a shadow of irony unheeded 
till the present century. Ironically enough, 
the Celts stood in awe of the laws of procre- 
ation, yet took the welfare of growing things 
as a matter of course ; but this blind-sided- 
ness was no more unreasonable than the 
joyous heralding of spring by laughing chil- 
dren, who in reality were hailing the hot, 
pestilential months destined to destroy count- 
less numbers among them. 

Winter has always taken its toll of lives by 
respiratory diseases and nutritional deficien- 
cies, but summer, with its hordes of flies, and 
scourge of putrefaction, has purged out the 
lives of millions of infants up to and includ- 
ing the beginning of the twentieth century. 
There are many now living who can recall 
the swathes cut in the ranks of year-old in- 
fants by the scourge called “second summer 
complaint,” a disease we now give the name 
of “infectious diarrhea,” and ward off by 
the simple expedient of carefully handling 
the baby’s food. 

For centuries, now, man has realized the 
importance of carefully cultivating his grow- 
ing crops, and safeguarding the health of his 
newborn animals ; but the full realization of 
his responsibility for the welfare of his own 
offspring, to say nothing of the mothers who 
bore them, lias only been brought about by 
the phenomenal advancements in medical 
science in the last one hundred years. 

The first real step towards a definite con- 
sideration for mothers was suggested by the 
works of Holmes and Semmelweiss, in the 
nineteenth century, but it remained for the 
last few decades to produce a definite move- 
ment towards the safeguarding of the new- 
born infant and the growing child. The doc- 
tor has fought his battle against invading 
disease for many more years, but national 
and international interest in disease preven- 
tion is comparatively recent. 

ETational interest in child health has 


78 


The Journal of the Maine Medical Association 


arisen, and mankind should bow its head in 
confessing it, as much from economic and 
social demands as from simple humanitarian- 
ism. A rising death rate in the face of a 
falling birth rate incident to war, and the 
financial pressure of an economic depression, 
are factors which bring an entire nation to 
realize the importance of protecting life and 
health, in order that society’s ranks may not 
be depleted, nor a costly burden of caring for 
the indigent sick be thrown upon the state. 

General disgust at “child labor” injustices 
during the last century gave physicians and 
farseeing crusaders an entering wedge for 
interesting society at large in generalized 
child health work. The origin of the Chil- 
dren’s Bureau, and even the Department of 
Labor, of the federal government was indi- 
rectly due to the national feeling aroused bv 
this movement. 

In 1916 the President endorsed the first 
Nationwide Baby Week, and Julia C. 
Lathrop, first Chief of the Children’s Bureau, 
in her annual report of that year, suggested 
that, May Day “might well be chosen as a day 
for the celebration of the increase in the 
common store of practical wisdom with 
which the young life of the Nation is guarded 
by each community.” 

Many people helped to bring about the 
celebration of May Day as a day for assessing 
child-health needs, and in 1928 a congres- 
sional resolution authorized the President to 
issue an annual May Day proclamation. In 
1935 the Association of State and Provin- 
cial Health Officers of North America asked 
the Children’s Bureau to sponsor May Day 
Child Health Day, and 1939 represents the 
fourth year of its sponsorship. However, 
celebrations in the states are largely due to 
the cooperative work of schools, local com- 
munity groups, and the state health depart- 
ments. 

In planning objectives for May Day Child 
Health Day programs, there are many prob- 
lems which might be taken as meriting the 
attention of the people of the State. For 
example, one might stress the importance of 
comprehensive ante-partum care for the 
mother to the survival and well-being of the 
unborn child. In the State of Maine, nine 
hundred to a thousand infants die before 
reaching the end of the first year ; and these 
deaths constitute nearly one-tenth of the total 


mortality. One-third of the infant deaths are 
due to premature birth, and an additional 
four hundred infants are stillborn ; both fig- 
ures being due, in part at least, to causes 
incident to the ante-partum period. The 
medical profession is fully conscious of its 
responsibilities, and it is awake to the need 
of combating the causes of these deaths, 
toxemia, malnutrition, and intercurrent dis- 
ease, to name a few ; but the public needs to 
be awakened to the importance of ante- 
partum care, and mothers made to realize 
their own responsibility to their unborn 
babies. 

If by one May Day program we could 
make the importance of ante-partum care 
universally understood, we would undoubt- 
edly reduce the two biggest factors in the 
infant death rate to a figure lower than ever 
before achieved. However, progress in these 
matters can only come by a slow process of 
education, and many other problems must 
occupy part of our time. Therefore, we must 
content ourselves with taking a small cut at 
the many risks which beset the growing child. 

The State May Day Committee, in plan- 
ning its program for 1939, has decided that 
it will not stress any child health problem to 
the exclusion of others. The cooperation of 
local groups, clubs, schools, and health agen- 
cies will be sought in carrying out a program 
designed to instruct children and parents in 
the importance of good health and ways of 
safeguarding it. These local activities will 
include health plays, pageants, and educa- 
tional talks by qualified speakers. In addi- 
tion, since the incidence of diphtheria has 
been high in Maine the past year, the Com- 
mittee urges that immunization clinics for 
the administering of toxoid be sponsored by 
local groups, arrangements to be made 
through the District Health Officer. 

The planning and execution of a program 
of health education for May Day Child 
Health Day is a humble start towards a solu- 
tion of the many child health problems, but 
it is a start. The May Day of 1939 is a far 
cry from the May Day of the Celts, and it is 
a glorious thing that our eyes may be turned 
from the wonders of the present to a com- 
prehending view of the needs of the future. 
Let us remember the words of the 1939 May 
Day Slogan, “The Health of the Child is the 
Power of the Nation.” 


Volume Thirty , No. 4 


The President's Page 


79 


The President’s Page 

To the Members of the Maine Medical Association : 

President Bunker has asked me to pinch-hit for him this 
month, and I thought that many, especially the Medical Examiners, 
would like to know how the Medical Examiner’s Bill is getting 
along. 

The Bill was drawn up by Attorney General Burkett, intro- 
duced by Representative. Peter Mills, and referred to the Commit- 
tee on Legal Affairs. 

The Attorney General made an excellent argument for the Bill 
at the hearing before the Committee. 

There was some opposition, and several amendments were 
suggested. 

The Committee reported promptly and unanimously that die 
Bill ought to pass without amendment. 

The House passed the Bill with an amendment allowing the 
present Medical Examiners to serve out their terms, and another 
allowing police officers to remove a body from the highway or 
similar place, before the arrival of the Medical Examiner. 

The Senate refused to accept the first amendment, and the 
House refused to recede. Therefore the Bill was referred to a 
joint Committee which we hope will be able to agree, and it would 
seem that it should, as the point on which there is disagreement is 
of no great importance. 

George L. Pratt, M. D., 
President-Elect Maine Medical Association 


80 


The Journal of the Maine Medical Association 


Editorial 

Sulfanilamide in the Treatment of Gonorrhea 


The clinical problem of the treatment of 
gonorrhea is just as important today as be- 
fore the discovery of sulfanilamide and its 
therapeutic value in this disease. Unfortu- 
nately the publicity associated with the drug 
has conveyed the erroneous impression, 
shared alike by the laity and some of the pro- 
fession, that today gonorrhea is a mere un- 
pleasant inconvenience and easily cured by 
the widely-publicized sulfanilamide. This is 
a most dangerous belief, since the cure of 
gonorrhea and hard clinical proof of that fact 
is not as simple as many enthusiastic reports 
would have us believe. Remission is far 
from a cure and clinicians of experience 
know full well that the immediate and dis- 
tant morbidity of the disease is serious and 
remotely, in the female, carries a definite 
mortality. This mortality arises from the 
serious pelvic conditions, occurring in no 
small percentage of carefully treated cases, 
since these sequelae require radical surgery 
for their cure. The time of this demand is 
often in the best years of a woman’s life and 
when required many times results in the 
complete sacrifice of the organs necessary for 
procreation and well being. The operation 
from a surgical standpoint may achieve com- 
plete success, but it often leaves a patient 
crippled from the standpoint of mental 
stability. 

Before the Section of Urology of the 1938 
session of the American Medical Association 
in San Francisco, published in the Journal 
for February 25th, Silver and Elliott re- 
ported their experiences in the treatment of 
1,625 cases of gonorrhea in the male with 
sulfanilamide. With the aid of sulfanilamide 
the authors believe that 75 per cent, of pa- 


tients with acute gonorrhea, in the male, can 
be cured in something like eight weeks. This 
is a most encouraging statement, but physi- 
cians in general to be assured of this happy 
result cannot hope to be so clinically for- 
tunate unless they follow in detail the me- 
thods and procedures required. The authors 
had an abundance of material, the work was 
most carefully conducted and the patients 
surrounded with every possible protection. 
Their report brought out, however, again the 
important fact that sulfanilamide is not a 
remedy to be handled with a careless dis- 
regard of its dangers and possibilities. 

It is imperative that the patient treated by 
this method be under careful supervision, 
the doctor alone should lie and is responsible 
as to how often a patient must report, but it 
must be stated that unhappy results and 
adverse reactions many times can occur with 
startling suddenness. Until there is pre- 
sented clinical evidence to the contrary — 
gonorrhea to be successfully treated demands 
maximum tolerance of the drug and this im- 
plies close observation of the patient. The 
laboratory methods required to detect early 
signs of trouble cannot be omitted without 
disaster, sooner or later, and it also must be 
admitted that the statement of Jones 1 of 
Seattle is true beyond equivocation: “Sul- 
fanilamide, while a most efficient remedy, 
had multiplied the difficulties of proving the 
presence or absence of gonococci. . . . Sul- 
fanilamide has multiplied the technician’s 
work and added greater uncertainty to the 
value of his result.” 

1 W. Ray Jones: Discussion on paper of Silver 
and Elliott. Journal A. M. A., Vol. 112, No. 8, Page 
728. 


Volume Thirty, No. 4 


Help Find Early Tuberculosis 


81 


The Eighty-Seventh Annual Session 


The eighty-seventh animal session of the 
Maine Medical Association will he held at 
Poland Springs, Sunday, Monday and Tues- 
day, June 25, 26 and 27, 1939. The central 
location of Poland Springs makes it the ideal 
spot for our annual meeting. The new man- 
agement has given us reduced hotel rates with 
free parking. Golf can he played all day on 
the beautiful eighteen-hole course, for one 
dollar. An orchestra will be available at din- 
ner, both for entertainment and dancing. 

Through the kindness of Col. Jim Camp- 
bell, who gave us Kenneth Roberts and the 
famous Italian surgeon, we have an enter- 
tainment for Sunday evening, by a nationally 
known prestidigitator. This is actually the 
tops in the field of mysticism. 

Monday and Tuesday mornings, the usual 
conferences will be held. The conferences 
this year, however, will be run differently, 
each conference lasting from 9.30 to 12.00, 
with a Chairman for each section. Several 
doctors will participate at each conference. 
Monday afternoon will be a Clinico-patlio- 
logical Scientific session. Monday evening, 
we have a fine speaker from Hew York. 


Tuesday afternoon, we will have three na- 
tionally known doctors for the scientific 
session. 

Me are pleased to announce that, for the 
banquet on Tuesday evening, Doctor Morris 
Fishbein, Editor of the Journal of the 
American Medical Association, will be with 
us and will give us the low-down on Social- 
ized Medicine, as dictated from Washington. 

Mrs. Bunker, the wife of our active Presi- 
dent, is planning special entertainment for 
the ladies, throughout the session. 

For those who are visualists and do not 
enjoy scientific speeches, we will have a num- 
ber of moving pictures on medical subjects. 
The scientific and drug exhibits will be better 
than ever. 

The weather man has promised us good 
weather, for a change, so come and bring 
along the ladies for all three days. I am sure 
that you will all be reimbursed in knowledge 
and a wonderful good time. 

Stephen A. Cobb, 
Chairman, Scientific Committee. 


Help Find Early Tuberculosis 


The Maine Public Health Association, 
authorized representative of the Xational 
Tuberculosis Association, asks everyone to 
Stop, Look, and Listen ! 

Why must eight out of every ten patients 
admitted to tuberculosis sanatoria have ad- 
vanced tuberculosis ? Are the doctors wholly 
to blame for this? Xo, but who is 2 ;oino’ to 
pick up the chronic spreader of the tubercle 
bacillus who does not think he is sick enough 
to go to a doctor ? 

Tuberculosis is still the leading cause of 
death from the age of fifteen to forty-five. 


Why, when tuberculosis is a curable disease? 
Tuberculosis should be a minor cause of 
death. Have we not boasted that the family 
doctor has acted from a certain sense of 
responsibility, not only for his families, but 
also for his locality ? 

Let us see to it that ideologists of federal 
treasury care and control of the sick, in their 
hunt for explosive arguments, find onlv 
“duds.” 

Be tuberculosis-conscious. Be tuberculosis- 
suspicious. Thus 


Help Find Early Tuberculosis 


82 


The Journal of the Maine Medical Association 


“The W omen s Field Army Is Ready to March 99 


The Women’s Field Army can report with 
a great deal of satisfaction that from Janu- 
ary 23 to March 21, seventy-three Districts 
have been organized for complete participa- 
tion in the 1939 educational and enlistment 
campaign. This is most encouraging, in view 
of the fact that almost all of this has been 
done by mail. It shows how great is the 
interest in the work of the Army all over the 
State, for every County is represented in the 
units organized. 

In addition to the Districts organized for 
active participation, approximately thirty 
will be covered by a direct mail appeal or a 
combination of letter and personal solicita- 
tion. Of this total, twelve Districts have 
never participated in previous campaigns. 

With the permission of the Maine Medical 
Association and of Dr. Edward H. Risley, 
Chairman of the State Advisory Board of the 
Women’s Field Army, copies of the very fine 
editorial on the Army appearing in the Feb- 
ruary issue of The Journal of the Maine 
Medical Association were sent to all the 
daily newspapers and several of the weeklies 
with the request that it be reprinted or an 
editorial be based upon it. This is bringing a 
most gratifying result and should answer 
conclusively the questions sometimes asked 
about the attitude of the physician and the 
Medical Association toward the work of the 
Women’s Field Army. 


Irvin Abell, M. D., President of the 
American Medical Association, praises the 
Women’s Field Army for enabling the medi- 
cal profession to apply more efficiently its 
constantly increasing fund of medical science 
about cancer in a statement made public 
recently. 

Dr. Abell's full statement follows: 

“One of the chief duties of the medical 
profession is the acquisition and advancement 
of medical knowledge. The responsibility 
for such accumulation rests solely on the pro- 
fession : Of equal importance is the dissemi- 
nation of this knowledge, which, while also 
a responsibility of the profession, is one 
gloriously shared by lay organizations. To 
none is more credit due for unselfish effort 
in this direction than to the Women’s Field 
Army of the American Society for the Con- 
trol of Cancer, which, bringing to the public 
factual data and knowledge concerning can- 
cer, enables the profession to apply more- 
efficiently the constantly increasing fund of 
medical science concerning it. This benevo- 
lent cooperation, actuated by an altruistic im- 
pulse to help one's fellowman, saves many 
lives that would otherwise be lost. The in- 
stances of man’s inhumanity to man lose 
ground and perspective in the light of this 
magnificent example of man’s humanity to 
man.” 


Graduate Education 


Commonwealth Fund Fellowships 

The attention of the members of the Maine 
Medical Association is called to the Fellow- 
ships available through the courtesy of the 
Commonwealth Fund. 

Information regarding these Fellowships, 
and application blanks may be obtained from 
the Division of Public Health, The Common- 
wealth Fund, 41 East 57th Street, Hew York 
City; Frederick T. Hill, M. D., Chairman 
of the Committee on Graduate Education, 
Waterville, Maine, or Frederick R. Carter, 
M. D., Secretary of the Maine Medical Asso- 
ciation, Augusta, Maine. 


A Course in Allergy 

A course in allergy is open, on application, 
to physicians of Maine under the auspices of 
the Bingham Associates. A fee of $25.00 is 
charged for the course, which is of one week's 
duration, but a Fellowship fee of $50.00 is 
allowed and physicians taking the course 
may obtain board and room at the hospital 
for $10.00. Full information is available 
from Frederick T. Hill, M. D., Waterville, 
Maine, or Frederick R. Carter, M. D., 22 
Arsenal Street, Portland, Maine. 


Volume Thirty , No. U 


County News and Notes 


83 


County News and Notes 


Androscoggin 

The March meeting of the Androscoggin County 
Medical Society was held at the Auburn Y. M. C. 
A., Thursday, the 16th, at 8.15 P. M. 

After a very short business meeting, an interest- 
ing paper on Pyuria in Infants ancl Children, was 
presented by Dr. Thomas A. Foster of Portland. 
The paper was discussed from a urologist’s point of 
view by Dr. Roderick Huntress, also of Portland. 
Several cases were pressnted with X-rays and an 
interesting discussion followed. 

Meeting adjourned at 10.30 P. M. 

W. P. Webber, M. D., Secretary. 


Cumberland 

A meeting of the Cumberland County Medical 
Society was held Friday, March 3, 1939. Dinner at 
the Eastland Hotel at 6.30 P. M. Dr. Leon Babalian 
and Dr. Albert D. Foster of Portland were elected 
to membership. The Panel Discussion of Cardio- 
vascular Diseases, Dr. E. E. Holt, Jr., Chairman, 
was presented. 

The following cases were presented at a Clinic 
at the Maine General Hospital at 4.30 P. M.: 

Dr. E. E. O’Donnell — Peripheral Embolism, after 
Pelvic Operation. 

Dr. Jack Spencer — Post-operative Parotitis. 

Dr. J. R. Hamel — Convulsive Seizure and Hemi- 
anesthesia. 

Dr. C. C. Corson — 1. Multiple Compound Frac- 
tures of Hand, with Gas Bacillus Infection. 2. 
Spiral Fracture of Femur, with Skeletal Fixation 
Applied under Novocain. 

Dr. H. M. Tabachnick — Unconsciousness and 
Glycosuria. 

Harold V. Bickmore, M. D., 

Secretary. 


Kennebec 

A meeting of the Kennebec County Medical Asso- 
ciation was held at the Augusta General Hospital, 
Thursday, March 16, 1939. 

Clinical session at 5 P. M. which was presided 
over by Leon D. Herring, M. D., President. 

(11 Syphilitic Aortitis — W. H. McWethey, M. D. 

(2) Luetic Hepatitis with Secondary Anemia — 
V. T. Lathbury, M. D. 

(3) Fractured Skull — Thomas F. Fay, M. D. 


(4) Complete Placenta Praevia — John Metzgar, 
M. D. 

(5) Intestinal Obstruction — Samuel H. Kagan, 
M. D. 

(6) Chronic Cholecystitis with complications — 
G. H. Lambert, M. D. 

Dinner at 6.30 P. M., followed by a business 
meeting. 

Minutes of the last meeting were read and ap- 
proved. 

Scientific Session at 7.30 P. M. 

Attorney Herbert E. Locke of Augusta spoke rel- 
ative to the bills introduced in the present session 
of the legislature which pertained to the medical 
profession. This talk was very interesting and 
stimulated a great deal of discussion. 

There were 33 members and guests present. 

Respectfully submitted. 

Frederick R. Carter, M. D., 

Secretary. 


Piscataquis 

A meeting of the Piscataquis County Medical 
Association was held in Sangerville, February 23rd, 
at Dr. Stuart’s office. The meeting was called to 
order by President Bundy. Communications from 
the Maine Medical Association were read. It was 
voted that the President appoint a committee to 
draw up resolutions on the death of Dr. D. L. Har- 
den of Brownville Junction, which death took place 
on February 6th. President Bundy appointed Drs. 
Crosby, R. H. Marsh and Pritham to this commit- 
tee. They retired and brought in their resolutions. 

Dr. Charles D. Cromwell of the State Sanatorium 
at Fairfield gave a talk on Tuberculosis. 

N. H. Nickerson, M. D., 

Secretary. 


New Members 

Cumberland 

Leon Babalian , M. D.. Portland. 
Albert D. Foster, M. D., Portland. 

Sagadahoc 

Albert S. Owen, M. D., Bath. 

E. M. Fuller, Jr., M. D.. Bath. 

Washington 
H. Grubin, M. D., Lubec. 


The Journal of the Maine Medical Association 


8U 


Coming Meetings 


County Medical Societies 
Cumberland 

Cumberland County Medical Society, H. V. Bick- 
more, M. D„ 723 Congress Street, Portland, 
Secretary. 

There will be a meeting of the Cumberland County 
Medical Society on Friday, April 21st, at the 
Eastland Hotel at 7.00 P. M. 

Speaker: Richard H. Overholt, M. D„ Boston, Mas- 
sachusetts. 

Subject: Some New Developments in the Manage- 
ment of Chest Lesions. 

This meeting will be preceded by a Clinic at the 
Maine General Hospital at 4.30 P. M. 


Kennebec 

Kennebec County Medical Association, Frederick 
R. Carter, Augusta, Secretary. 

April 20, 1939, at the Gardiner General Hospital. 
Speaker: Samuel Levine, M. D., Boston. Subject: 
The Ausculation of the Heart. 

May 18, 1939, at the Veterans’ Administration at 
Togus, Maine. 


Knox 

Knox County Medical Association, A. J. Fuller, 
M. D., Pemaquid, Secretary. 

The next meeting of the Knox County Medical As- 
sociation will be held Tuesday, April 11th, at 
The Copper Kettle, Rockland, at 7.00 P. M. 
Speaker: Dr. Tannhauser, Boston, Massachu- 

setts. Subject: Vitamin Deficiencies. 


American Medical Association 

American Medical Association, St. Louis, 
May 15-19, 1939 


State Medical Associations 

Connecticut State Medical Society, New Haven, 
May 25-26. Creighton Barker, 258 Church 
Street, New Haven, Connecticut, Secretary. 

Maine Medical Association, Poland Springs, June 
25-26-27. Frederick R. Carter, 22 Arsenal 
Street, Portland, Maine, Secretary. 

Massachusetts Medical Society, Worcester, June 

6- 7-8. Alexander S. Begg, 8 Fenway, Boston, 
Massachusetts, Secretary. 

New Hampshire Medical Society, Manchester, June 
8-9. C. R. Metcalf, 5 S. State Street, Concord, 
New Hampshire, Secretary. 

Rhode Island Medical Society, Providence, June 

7- 8. Guy W. Wells, 124 Waterman Street, 
Providence, Rhode Island, Secretary. 

Vermont State Medical Society, Burlington, 1939. 
Benjamin F. Cook, 46 Nichols Street, Rutland, 
Vermont, Secretary. 


Available Panel Discussions 


The following panel discussions are avail- 
able to County Societies and dates for any of 
them may be arranged by conferring direct 
with the Chairman of the different panels or 
Frederick T. Hill, M. D., The Professional 
Building, Waterville, Maine. 

1. Pneumonia : Frederick T. Hill, M. 1)., 

Waterville, Chairman. 

2. Cardio- Vascular Diseases : E. E. Holt, 

Jr., M. 1)., Portland, Chairman. 

3. Fractures: Allan Woodcock, M. I)., 

Bangor, Chairman. 


4. Laboratory Methods and Their Rela- 

tion to Clinical Examination : 
Julius Gottlieb, M. D., Lewiston, 
Chairman. 

5. Acute Appendicitis: F. H. Jackson, 

M. I)., Houlton, Chairman. 

6. Cancer : E. H. Risley, M. D., Water- 

ville, Chairman. 

7. Surgery of the Thorax: George E. 

Young, M. D., Skowliegan, Chair- 


man. 


Volume Thirty, No. U 


Notices 


85 


Necrologies 


Orville Leon Hanlon, M. D., 
1875-1938 

The death on December 10, 1938, of Doctor Or- 
ville Leon Hanlon, 63, of Mexico, Maine, marked 
the passing of one of the outstanding physicians 
and surgeons of Oxford County. 

Doctor Hanlon was born March 28, 1875, in 
North Andover, Massachusetts, the son of Peter 
Francis and Annie P. Worthington Hanlon. 

He received his preliminary education in Berlin, 
New Hampshire. After graduating from the High 
School, he entered Bowdoin College and received 
his A. B. degree in 1897 and his M. D. degree in 
1901. Doctor Hanlon entered the practice of medi- 
cine in Ridlonville (Mexico), Maine, and contin- 
ued there until his death from Coronary Throm- 
bosis. He enjoyed a large practice and was on the 
Surgical Staff of the Rumford Community Hospi- 
tal. He was a member and past president of the 
Oxford County Medical Society, a member of the 
Maine Medical Association and the American 
Medical Association. He was a member of the 
Walton Lodge, Knights of Pythias, of Mexico, and 
of the Rumford Lodge of Elks, and a member of 
the School Board for a number of years. 

He is survived by his widow, who was Miss 
Mildred B. Woodwaid of Ridlonville, his mother, 
who resides in Ridlonville, a son. Dr. Francis 
Hanlon of Portland, and two grandsons, Peter 
Francis Hanlon and Nicholas Richard Hanlon of 
Portland. 


Frank Washington Tarbell, 
M. D., 1879-1939 

Frank W. Tarbell, M. D., for many years a prac- 
titioner at Smyrna Mills, died suddenly at his home 
early Saturday, February 25th. He was born in 
Dyer Brook, July 31, 1879. With the exception of a 
short time in Massachusetts had always practiced 
in Smyrna Mills. Dr. Tarbell for the past few years 
had not been in the best of health but had carried 
on an extensive country practice and the day be- 
fore his death went about his calls as usual. 

He was a former member of the Aroostook Coun- 
ty Medical Society, had served on several commit- 
tees and also as its President, but of late years had 
not been a member. He is survived by his widow 
and one daughter. 


Daniel Nash W oodman, M. D., 

1861-1938 

Doctor Daniel Nash Woodman, 77, of North 
Haven, died at Portland, November 26, 1938. He 
was born at Sweden, Maine, March 31, 1861, and 
graduated from the College of Physicians and 
Surgeons, at Baltimore, Maryland, in 1893. Doctor 
Woodman practiced in Yarmouth for thirty-five 
years and in North Haven for eight years. He was 
a member of the Cumberland County Medical 
Society. 


Notices 


Teaching Clinic 

Central Maine General Hospital 
Lewiston, Maine 
April 28, 1939 (Friday) 

9.30 A. M.-12.00 M. Clinic to be conducted by Dr. 
John Fraser. 

Demonstrations and Discussions — 

1. Chronic Pelvic Infection. 

2. Carcinoma of Cervix. 

3. Idiopathic Uterine Bleeding. 

3.00 P. M.-5.00 P. M. Ward Walks and Round 
Table Discussions on Obstetrical and Gynecologi- 
cal Problems. 

8.00 P. M. “The Treatment of Hemorrhage in 
Late Pregnancy” by Dr. John Fraser, Professor of 
Obstetrics and Gynecology, McGill University Med- 
ical School. 

Teaching Clinic Committee, 
Central Maine General Hospital. 


Gerrish Library Anniversary Clinic 
Central Maine General Hospital 
Lewiston, Maine 

May 19, 1939 

Evening Speaker: Dr. Jonathan C. Meakins, 

Professor of Medicine, McGill University Medical 
School. 

Paper: “Doctors and Libraries.” 

Full Clinic Day. 

Teaching Clinic Committee, 
Central Maine General Hospital. 


1939 State May Day C ommittee 

The State May Day Committee for 1939 held its 
first meeting at Augusta, March 22nd, to formulate 
plans for the present year. The Committee as ap- 


86 


The Journal of the Maine Medical Association 


pointed by the State Chairman, Robert R. Jewett, 
M. D„ Director of the Division of Maternal and 
Child Health, is as follows: 

Thomas A. Foster, M. D„ Portland 
Mr. Edward E. Roderick, Department of Edu- 
cation, Augusta 
Mrs. Ralph Ingraham, Augusta 
Mrs. Theresa Anderson, Augusta 
Miss Florence Jenkins, Department of Educa- 
tion, Augusta 

Miss Edith Soule, Division of Public Health 
Nursing, Augusta 

Mr. C. Harry Edwards, Department of Educa- 
tion, Augusta 


Bureau of Health 
Services for Crippled Children 
1939 


American Association of Obstetricians 

The American Association of Obstetricians, 
Gynecologists and Abdominal Surgeons announces 
that the annual Foundation Prize for this year will 
be $100.00. Those eligible include only (1) interns, 
residents, or graduate students in Obstetrics, Gyne- 
cology and Abdominal Surgery, and (2) physicians 
(M. D. degree) who are actually practicing or 
teaching Obstetrics, Gynecology or Abdominal 
Surgery. 

Competing manuscripts must (1) be presented in 
triplicate under a nom-de-plume to the Secretary 
of the Association before June 1st, (2) be limited 
to 5,000 words and such illustrations as are neces- 
sary for a clear exposition of the thesis, and (3) 
be typewritten (double-spaced) on one side of the 
sheets, with ample margins. 

The successful thesis must be presented at the 
next annual (September) meeting of the Associa- 
tion, without expense to the Association and in 
conformity with its regulations. 

For further details, address Dr. James R. Bloss, 
Secretary, 418 11th Street, Huntington, W. Va. 


Clinic Schedule 


Rumford : 


Machias: 


Lewiston : 


Bangor: 


Portland : 


Rumford Community Hospital — 1.00 
P. M. to 3.00 P. M., Wednesday, 
May 24th. 

Washington State Normal School — 

1.00 P. M. to 3.00 P. M„ Wednes- 
day, April 26th. 

Central Maine General Hospital — 

9.00 A. M. to 11 A. M„ Saturday, 
April 29th, May 27, June 24th. 

Eastern Maine General Hospital — 

1.00 P. M. to 3.00 P. M., Thursday, 
May 4th, June 1st, June 29th. 

Children's Hospital — 9.00 A. M. to 

11.00 A. M„ 1.00 P. M. to 3.00 P. 
M„ Monday, April 10th, May 8th, 
June 12th. 


Presque Isle: Northern Maine Sanatorium — 9.00 

A. M. to 11.00 A. M„ 1.00 P. M. to 

3.00 P. M., Tuesday, May 16th. 


Rockland: Knox County Hospital — 1.30 P. M. 

to 3.00 P. M., Thursday, June 15th. 

Waterville: Thayer Hospital — 1.30 P. M. to 3.00 

P. M., Wednesday, May 31st. 

Note: No Clinic appointments can be made for 

patients during the last five days prior to the Clin- 
ic except for cases who are referred in directly by 
physicians. 


American Association of Industrial 
Physicians and Surgeons 

The 24th annual meeting of the American Asso- 
ciation of Industrial Physicians and Surgeons 
with the American Conference on Occupational 
Diseases and Industrial Hygiene will be held at 
the Hotel Statler, Cleveland, Ohio, June 5, 6, 7 and 
8, 1939. 

Information regarding hotel accommodations, 
etc., may be obtained from A. G. Park, Convention 
Manager, 540 North Michigan Avenue, Chicago. 


Annual “Radium IS umber' Mississippi 
Valley Medical Journal 

The March issue is the twelfth annual “Radium 
Number” of the Mississippi Valley Medical Journal 
(Incorporating the Radiologic Review), published 
at Quincy, Illinois. This contains ten original arti- 
cles. written especially for this issue, the most of 
which are contributed by well-known American 
radiologists. 

Pohle of the University of Wisconsin, has an in- 
teresting article on angiofibroma and gives a case 
report showing an excellent result with interstitial 
radium. Jorstad of St. Louis, shows the effective- 
ness of interstitial radiation in certain locations. 
Levin of New York City, shows the importance of 
effective radium therapy in prostatic and bladder 
cancer. Swanberg of Quincy, has a valuable con- 
tribution entitled “What Radiation Technic Gives 
the Rest Clinical Results in Uterine Cervical Can- 
cer?”, which is a statistical study of the five year 
end-results in 3,759 treated patients. There are a 
number of other interesting articles, including an 
editorial on “The Radium Rental Controversy”; 
in the latter, the editor points out the evils of the 
recently inaugurated long time, unsupervised, ra- 
dium “leasing plan” and compares it with the more 
conservative, short time, supervised, radium “rent- 
al plan” which has been in use for the last quarter 
of a century. 


American Physicians' Art Association 

The American Physicians’ Art Association com- 
posed of members in the PTnited States, Canada, 
and Hawaii, will hold its second Art Exhibit in the 
City Art Museum of St. Louis, May 14-20, 1939, dur- 
ing the annual session of the American Medical 
Association. Art pieces will be accepted for this 
art show in the following classifications: (1) oils 
both (a) portrait and (b) landscape, (2) water 
colors, (3) sculpture, (4) photographic art, (5) 
etchings, (6) ceramics, (7) pastels, (8) charcoal 
drawings, (9) book-binding, (10) wood carving, 
(11) metal work (jewelry). Practically all pieces 
sent in will be accepted. There will be over 60 
valuable prize awards. For details of membership 
in this Association and rules of the Exhibit, kindly 
write to Max Thorek, M. D., Secretary, 850 Irving 
Park Blvd., Chicago, Illinois, or F. H. Redewill, 
M. D., President, 521-536 Flood Bldg., San Francis- 
co, California. 


Volume Thirty, No. U 


Book Reviews 


87 


Book Reviews 


“The Biology of Human Conflict — An 
Anatomy of Behavior Individual 
and Social ” 

By Trigant Burrow, M. D., Ph. D., Scientific 
Director, The Lifwynn Foundation, New York 
City. 

Published by The Macmillan Company, 60 Fifth 
Avenue, New York, 1937. Price, $3.50. 

Dr. Burrow has set for himself a most difficult 
task and has placed obstacles, which at the present 
state of human knowledge appear almost insur- 
mountable, upon the road which the medical pro- 
fession must travel in order to reach their ulti- 
mate goal, a more perfect human society. More 
than fifteen years ago Dr. Burrow set out to dis- 
cover if possible the cause or causes for mankind’s 
most disastrously destructive form of insanity, 
that form of insanity which displays its kaleido- 
scopic symptomatology daily for our senses to per- 
ceive, elaborate and act upon, human fears and 
human hates as they are actively expressed in our 
everyday behavior. The fears and hates of man- 
kind, directed not only by man against man, man 
against woman, woman against man, woman 
against woman, etc., etc., but directed also against 
the creations of man’s imagination which in their 
turn initiate new forms of fears and hates, are 
only part of a long chain of causes for human con- 
flicts and maladjustments which often impel man 
to actions quite contrary to his natural human 
inclinations and often contrary to his best inter- 
ests. When the action of these disharmonious 
forces produces impressions which lead to irre- 
versible memory constructs and action currents, 
we suffer from progressive but disintegrative dis- 
turbance of peace of mind and feeling of human 
kindness. This is true whether we are afflicted as 
an individual or as a member of a smaller or 


larger organized group of similarly situated indi- 
viduals. 

With truly scientific enthusiasm and personally 
disinterested determination the author works per- 
sistently in search of and hope for finding the 
causes and possible cures for the many forms of 
pathologic biologic adjustments which torment 
“normal” modern mankind. He labors patiently 
in the service of truth. From time to time he has 
published the results of his investigations in book 
form as well as in several national and interna- 
tional journals. 

The present volume appears to be a sort of sum- 
mary of the work so far accomplished and points 
the way which we must travel if we hope to attain 
a more profound insight into the nature of the 
basic foundations of human conflicts and the vari- 
ous forms of maladjustment and associated de- 
fense reactions which result therefrom. Some help- 
ful suggestions are offered which may lead to the 
possible discovery of practicable dependable re- 
medial agencies with which to successfully meet 
the various critical situations as they arise. The 
sincerity of the author and his conviction that he 
is in possession of truths founded upon scientific 
experiment and experience is excellently expressed 
in the following quotation, taken from the volume 
under review: “If medicine is adequately to ap- 
praise the condition of division and conflict exist- 
ing within the community under its guise of ‘nor- 
mality,’ we shall have to adopt a fundamentally 
altered attitude toward the problem of mental 
disease. We shall have to apply to these manifes- 
tations the same qualitative methods of study that 
have characterized medical research in other fields. 

“The absence of peace, of order within the pro- 
cesses of man is world-wide. But this lack of har- 
mony is not resident within the sphere of man’s 
ideas. It is not to be found in his political dis- 


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88 


The Journal of the Maine Medical Association 


sensions, liis religious disparities, his social and 
economic conflicts. Neither is the seat of his dis- 
order to be found in what has been described as 
his neurosis, crime or insanity. These manifesta- 
tions are but the external signs. The real disorder 
consists of a lack of coordination and peace that 
is primary and internal to man. The disorders of 
behavior we have called mental are to be found 
in organic processes that are as clearly demon- 
strable objectively, qualitatively, as the disordered 
processes responsible for other diseases occurring 
within the organism. 

“Man is undoubtedly ill-adjusted and unhappy. 
There is not alone the ill health of the individual 
but of nations, of the world at large. Philosophy, 
metaphysics, academic education, politics or eco- 
nomics will not avail. The need is definitely a 
physiological one. In the disturbance of order and 
harmony within man’s personal and social pro- 
cesses we are confronted with basic, underlying 
causations internal to the organism. We are con- 
fronted with a fundamental disturbance in the 
internal motivations of man as a species. The 
investigations of individuals and of groups, as con- 
ducted by the scientific staff of the Lifwynn Foun- 
dation, have made evident that these internal dis- 
harmonies in behavior-motivation are traceable to 
a conflict between definite neuro-muscular patterns 
of reaction. They have made it evident that as 
these patterns are physiological and internal to 
the organism they may become perceptible and 
amendable to remedial measures only in the de- 
gree in which medicine adopts an internal tech- 
nique of procedure that will give to these processes 
clear physiological definition and enable us to 
deal with them in their immediate underlying 
objectivity. When disorders of human behavior, 
individual and social, have been stripped of their 
purely ideological, metaphysical implications and 
we have assumed toward them the same scientific 
attitude we have adopted toward clinical disease- 
process as it occurs in this or that specific organ 
or tissue of the individual— only then will medi- 
cine have fulfilled the full scope of its obligation 
to deal objectively with disordered human pro- 
cesses.” 


“Syphilis” 

Edited by Forest Ray Moulton. The Science 
Press, Lancaster, Pa., 1938. 

This is the third medical symposium of the 


American Association for the Advancement of 
Science. Previously published symposia were “The 
Cancer Problem” (1937) and “Tuberculosis and 
Leprosy” (1938). The next one to be published in 
1939 is “Mental Health.” Each symposium is or- 
ganized by the secretary of the section in co- 
opei'ation with a committee of eminent experts on 
the subject to be discussed. 

Syphilis is considered to be the most serious 
public health problem in the United States. Until 
about thirty years ago not even the cause of this 
disease was known, much less its cure. Now the 
various co-authors of this symposium show us 
that syphilis, like many other diseases, has many 
relatives, the most common being Yawes and 
Bejel. They also show us by so-called documentary 
evidence that the notion or belief that syphilis 
was contracted by some of Columbus’ sailors while 
in Haiti, transported to Barcelona and transmitted 
with wildfire rapidity to all parts of Europe with- 
in a very few years with the result that thousands 
of sufferers died during an epidemic, may be erro- 
neous. 

There are many other illuminating remarks 
made by everyone of the thirty contributors, in 
regard to diagnosis, treatment, control and prog- 
nosis of this disease complex, commonly known 
by the name syphilis. It is worth while scientific 
medical literature plainly stated. 


“Surgical Treatment of Hand and 
Forearm Infections” 

By A. C. J. Brickel, A. B., M. D., Department of 
Anatomy and Surgery, Western Reserve Univer- 
sity, with 166 Text Illustrations and 35 plates, in- 
cluding 10 in color. Published by the C. V. Mosby 
Co., St. Louis, 1939. Price, $7.50. 

The human hand plays a highly significant part 
in industrial medicine. Minor injuries to a finger 
often lead to prolonged incapacitation of the hand 
for purposes of gainful employment. Even when 
correctly treated by the attending physicians, un- 
wholesome criticism is often voiced. Dr. Brickel 
has laboriously tried to discover possible reasons 
for troublesome complications which often foliow 
apparently appropriate and successful initial thera- 



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Volume Thirty, No. 4 


Book Reviews 


89 


peutic measures. With the help of diligent labora- 
tory and X-ray experimentation, he has developed 
a form of treatment which, if faithfully carried out, 
promises more positive results than were possible 
by the trial and error method of former years. Very 
valuable suggestions are presented concerning the 
use of local anesthetics, the rules of probability for 
the spread of infections, as well as definite instruc- 
tions for conservative efficient surgical and medi- 
cal care with a view toward the attainment of best 
possible utilitarian results with the least possible 
loss of time from unemployment. 


“ The Complete Guide to Bust Culture ” 

By A. F. Niemoller, A. B„ M. A., B. S., with a 
Foreword by Edward Bodolsky, M. D. Published 
by the Harvest House, New York, 1939. Price, $3.50. 

It is claimed that this is the first and only book 
in any language written for the purpose of pre- 
senting in non-technical language methods for the 


care of what must hereafter be called the bust. 
According to the author, the terms breast, bosom 
and bust are frequently employed interchangeably, 
which is very wrong. “Properly speaking, breast 
refers to the mammary glands, of which a woman 
normally has two, and takes account of it as a func- 
tioning organ as well as a shaped appendage of 
the body. Bosom, on the other hand, connotes the 
shape and substance of the two breasts taken as a 
unit portion of the female body and concerns large- 
ly only the exterior aspects. But bust is the broad- 
est of them all; it refers not only to the two breasts 
considered together in the sense of bosom, but also 
to the contour of their blending with the sweep of 
the chest above and the lines of the body immedi- 
ately below.” 

In twenty-three chapters the lay reader is told 
what she can do or have done for the purpose of 
improving her bust contour. “All lotions and de- 
vices and most of the popularized ‘treatments’ are 
wholly useless.” Physical exercise, appropriately 
selected, well fitted brassieres and skillfully per- 
formed corrective plastic surgery are discussed at 
length. 


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IX 


LABORATORY TESTS 

over a period of years have shown the thermal 
death point of brucella abortus to be 125° F. for 
30 minutes or 142° F. for 7/^ minutes. This is, 
of course, well within the pasteurizing range. 

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The Journal 

of the 

Maine Medical Association 


Uolume Thirty Portland, Ulaine, mai|, 1939 


No. 5 


Cutaneous Burns 

By Gordon 1ST. Johnson, M. D., Portland, Maine 


These injuries are so common as to consti- 
tute a real problem in therapy. One finds a 
multiplicity of treatment, some good, some 
not so good. It is a source of annoyance for 
one being called to treat a burn to find some 
form of grease applied. 

In no condition in surgery is there more 
need for care in the details of treatment or 
more urgent demand for careful nursing. 
The surgeon should consider in his plan of 
therapy not only the burned area, but the 
treatment of the individual as well. 

Classification : 

1. Thermal. 

Fire, boiling liquids. 

2. Electrical. 

3. Chemical. 

Local Pathology : 

“A first degree burn clinically is an 
erythema or reddening; of the skin without 
evident damage. There may be a desquam- 
ation of superficial epithelium in a day or 
two, followed by subsidence of hyperemia.” 
“A burn of the second degree is accom- 
panied by reddening and blisters, destroy- 


ing all the epidermis but that dipping into 
the hair-follicles.” 

“The third degree burn involves the 
tissue beneath the skin down to and even 
including bone.” 

Burns in general are characterized by a 
terrific over-response and local congestion and 
engorgement far beyond that seen follow- 
ing other traumata producing the same 
amount of tissue damage. The tremendous 
edema, exudation and infiltration of the tis- 
sues in and about the burned area is respon- 
sible for the extremely painful nature of 
burns. 

In third degree burns of any depth the 
pathological picture is serious. Surrounding 
the area of necrotic skin and tissue beneath 
there will be a zone of intense inflammatory 
reaction, fading out gradually into the rela- 
tively normal tissue of the uninjured por- 
tion. This is a zone of marked swelling, red- 
ness, heat, pain and tenderness. The dead 
tissue is often white at first ; later, as drying 
sets in, it becomes darker in color, until it is 
finally seen as a black slough in the process of 
separation. These appearances are often al- 
tered bv the fact that blisters may cover the 
surface of what really is a severe burn. The 


MEDICAL 


u, 


S O O A DV 
SOrAiHi \ » 


UNIVERSITY OF MARYLA? 


92 


The Journal of the Maine Medical Association 


intense inflammatory zone represents a line 
of demarcation. 

General Pathology : 

Several theories have been advanced to 
account for death occurring* in from six to 
ten days of symptoms suggestive of tox- 
emia. Robertson and Boyd burned the skin 
of young rabbits. In one series the burned 
skin was removed within eight hours and 
grafted to an unburned rabbit ; the skin 
of the latter being grafted to the former. 

Toxemia developed in the rabbits receiving 
the burned transplants, but none of the 
others were affected. If, however, the 
transplants were made after eight hours 
both series of rabbits exhibited evidences 
of toxemia. They further showed that the 
serum of burned children, when injected 
into rabbits was innocuous, but the injec- 
tion of citrated whole blood caused typical 
toxemia. 

There is marked concentration of the blood 
ranging up to 200% of normal; the sodium 
chloride content shows an inverse ratio to the 
concentration by the haemoglobin. 

Fever is a constant symptom and remains 
for a week or ten days and then subsides. If 
no subsidence or the temperature is spiking 
it is an ominous sign. The extensive burns 
reveal shock with its classical signs of pallor, 
sweating, wide-awake consciousness, rapid 
shallow respiration, a feeble rapid pulse and 
low blood pressure. 

Pain may be severe, at other times com- 
plained of little, if at all. Vomiting may be 
present. Ulcers of the stomach or other parts 
of the gastro-intestinal tract are mentioned in 
the literature, Curling first reporting such 
cases in 1842. Since then few reports of such 
have been forthcoming; though Weiskoten 
and Bardeen have reported numerous small 
ulcers of the small intestine in their studies. 
Focal necrosis and hemorrhage have been 
observed in the suprarenals. 

Immediate Treatment: 

As soon as the patient is seen morphia up 
to physiological affect should be given imme- 
diately, the clothing should be carefully re- 
moved, cut away if adherent in any part. If 


in shock, treat the shock with infusions of 
isotonic saline and 5% glucose. Then the 
burned area is carefully debrided using ster- 
ile forceps and scissors. This done under 
anesthesia. The area then is scrubbed gently 
with soap and water followed by ether. 

As soon as the necrotic debris is removed 
apply a freshly-made-up 5% solution of tan- 
nic acid. This may be sprayed on or applied 
with sterile gauze. (A 5% solution can 
roughly be prepared by 5 teaspoonsful of 
Tannic Acid powder added to a glass of 
water.) In ten minutes follow this with a 
10% solution of Silver Nitrate. Immedi- 
ately there is eschar formation and the split 
nucleo-proteins have been precipitated. The 
eschar is firm and leathery and no dressing 
need be applied. The patient is given a 
prophylactic dose of antitetanic serum and 
gas serum, also scarlet fever antitoxin. 

Alien in bed cradle with lights is insti- 
tuted and fluids forced. Because of the ease 
and quickness with which the tannic acid sil- 
ver nitrate procedure can be instituted it is 
a time-saving and patient-saving devise. In 
the place of this, 1% aqueous solution of 
gentian-violet may be applied. The great 
tendency has been to apply too many appli- 
cations. Enough only to insure eschar for- 
mation should be used. 

As the epithelium begins to grow from the 
islands the eschar tends to raise and separate, 
to curl at the edges. This should be trimmed 
with a pair of sharp scissors. As the granula- 
tions become healthy the eschar likewise 
tends to separate. It is now that grafting* 
should be done, not waiting for deep cicatri- 
zation to take place with resulting 11011 -takes 
of the grafts. The area, if slightly septic, 
may be readily cleaned by the use of 1-5000 
neutral solution of acriflavine applied as wet 
dressings. Picric acid should not be used in 
extensive areas because of the possible toxic 
result of the phenol radical ; chlorinated 
dressings macerate the tender new epithel- 
ium ; Boric likewise has similar action. 

If the burned area becomes septic the 
eschar will be raised over the purulent sec- 
tion. Remove and start 1-5000 acriflavine 
wet dressings. The dressings may be changed 
once in twenty-four hours. 

Small transfusions, a liberal diet, high in 
vitamins, particularly vitamin C and vitamin 


Volume Thirty, No. 5 


Cutaneous Bums 


93 


A, all aid to the rapid recovery of the patient. 
Chlorides in the form of infusion, or sodium 
chloride in capsules, 5 grs. three* times daily 
for several days will prevent depletion of the 
blood chloride values. If pinch grafts have 
been used and seem to be doing poorly place 
the patient in a tub of warm water and gent- 
ly with the finger rub the grafted area. 
Debris is removed and a singular stimulation 
of epithelium is noted. If prior to the graft- 
ing the granulation seems sickly a wet dress- 
ing of amfetin brings about excellent results. 

When the eschar has been removed a deli- 
cate pink epithelialization is noted. To pre- 
vent Assuring gently massaging with olive oil 
two or three times a day gives very pleasing 
results. 

In the event burns have occurred over 
joints these should be placed in extension and 
kept there until active mobilization is pos- 
sible. Many unsightly and crippling defor- 
mities due to retractions of cicatrices could 
be prevented if this simple procedure were 
enforced. 

Chemical burns are best treated by the con- 
tinued application of water to prevent the 
agent from penetrating deeper. 

Electrical burns penetrate much deeper 
than is at first apparent. Debridement with 


subsequent grafting prevents the toxic mani- 
festation of absorption of the split muscle 
proteins. 

Conclusions : 

1. Burns classified as to etiology and 
severity. 

2. Pathology — local and general. 

3. Treat the patient for shock, anemia 
and depletion of blood chlorides. 

I. Local treatment of debridement, tho- 
rough cleansing, applications of 5% 
solution of tannic acid followed in ten 
minutes by 10% solution of Silver 
Hitrate. 

5. Early grafting to prevent cicatrix 
formation. 

6. Extension of joints where burns in- 
volve these. 

References : 

Davidson, E. C.: Tannic Acid in Treatment of 
Burns. 8. G. 10, 41:202, 1925. 

Weiskoten, H. G. : Histopathology of Superficial 
Burns. J. A. M. A. 72; 259, 1919. 

Homans, John: A Test Book of Surgery, 107, 

1932. 

Murray, C. R.: The Treatment of Injury, Vol. 1, 
52, 1931. 

Bancroft, F. W.: Nelson’s Loose-Leaf Surgery, 

Chapter VIII, Vol. I. 


Appendicitis in Children 

Too many children die from the complica- 
tions of appendicitis. . . . The obvious solu- 
tion to this situation is early diagnosis and 
early operation, which limits the problem to 
one of acute appendicitis without complica- 
tions. In this stage of the disease the mor- 
tality is negligible. . . . The unwise use of 
cathartics in the presence of abdominal pain 
is an important factor in causing peritonitis 
to result from appendicitis and in keeping up 
the high mortality. . . . Delayed operation or 
the Ochsner treatment is probably less effec- 
tive in the child than in the adult, but is 
occasionally desirable, even in the child. Its 
employment should be limited to surgeons of 
experience. When incorrectly used and mis- 
applied, it is harmful, not helpful.— William 
E. Ladd, M. D., The New England Journal 
of Medicine, Vol. 219, ETo. 10, pp. 329-333, 
September 8, 1938. 


Transfusion Anuria 

Doctor E. Granville Crabtree of 99 Com- 
monwealth Avenue, Boston, Massachusetts, 
is attempting to assemble sufficient pathologi- 
cal material on the kidney in misfit trans- 
fusion anuria in pregnancy to enable him to 
place this subject in a book on urinary dis- 
eases in pregnancy. Because of the frequent 
need for transfusion in obstetrics there are 
cases of this nature in considerable number 
but they are widely scattered. Dr. Crabtree 
will appreciate notes, pathology reports and 
pathological slides which you may be able to 
contribute and will give proper credit for 
material used in publication. 

-H- 


94 


The Journal of the Maine Medical Association 


Acute Hemorrhagic Encephalitis 

Report of a Case 


By H. I. Goldman, 

Acute hemorrhagic encephalitis of the 
Strumpell type usually occurs in infancy 
and early childhood, and occasionally in 
adults. This type is diffuse, involving all of 
the structures of the brain. It follows an 
acute general infection, such as influenza, 
measles, or scarlet fever. 

The following is a case report of an adult 
with one attack relieved, but a subsequent 
attack proving fatal. We were fortunate in 
obtaining permission for a post mortem, 
which, although limited to the head, proved 
valuable. 

Case Report 

F. M. White male. Age 69. Retired 
school teacher. 

Chief Complaint : Severe cough, tempera- 
ture, stupor. 

Present Illness : Two weeks ago a physi- 
cian saw the patient and made a diagnosis of 
“grippe.” The patient apparently recovered 
from this infection in five days. Eight days 
later the patient began to show periods of 
apparent stupor interspersed with periods of 
delirium reaching the point where force 
would be necessary to put the patient to bed. 
The next morning when he failed to improve, 
a physician was called. 

Family History: Married twice. First 

wife died of cancer. Father died of tuber- 
culosis ; mother of cerebral hemorrhage. 

Past History: Usual childhood diseases. 
Pneumonia IT years ago. Grippe 5 years 
ago. Up to two years ago the patient was 
employed in the department of education in 
another state in an executive capacity. He 
had been a teacher since his graduation and 
had been considered as having a more than 
average intellect bv impartial observers. Two 
years ago both the patient and his wife no- 
ticed that his mental capacity and per- 
sonality were changing for the worse. A 
competent neurologist was consulted, who 
made a diagnosis of early cerebral arterio- 
sclerosis. The patient resigned his job and 


M. D., Freeport, Maine 

retired. Since retirement his wife noticed 
that he had become slovenly about his hereto- 
fore immaculate appearance, lost his powers 
of concentration on any one given subject, 
and was disoriented in his speech. 

All of this history was obtained from his 
wife. At no time up to the death of the 
patient were we able to get any story from 
the patient himself. 

Physical Examination : Showed a well- 

developed and fairly well-nourished white 
male, lying in bed, moaning softly, and hard 
to arouse. T. 103.6 F. rectal. Pulse 110 — 
full and bounding, Resp. 30 — shallow. 

Head: Xo abnormalities or evidence of 
injuries. 

Eyes : Pupils equal but react very slug- 
gishly to light. Ophthalmoscopic examination' 
showed the fundic vessels to be very tortuous 
and full. The margins of the optic discs were 
poorly defined. There were no exudates or 
hemorrhages visible in the fundi. 

Ears, Nose, Throat : Essentially negative. 

Xeck : X o palpable glands. Thyroid not 
felt. 

Chest : Dullness over both bases with de- 
creased tactile fremitus and diminished 
bronchial breath sounds. Xumerous moist 
rales were heard over both bases. Heart 
sounds were regular with no murmurs or 
other abnormalities. 

Abdomen : Essentially negative. 

Xeurological : Xeck rigid. Arms spastic 
and no reflexes obtainable. Knee jerks slight 
to absent on both sides. Bilateral ankle 
klonus, more so on the left. Xegative Babin- 
ski. Ankle jerks, abdominals, cremasteric 
reflexes absent. 

A clinical diagnosis of either brain abscess 
or encephalitis was made and the patient was 
hospitalized at the State Street Hospital, 
Portland. 

Course at Hospital : On admission an im- 
mediate lumbar puncture was done. The 
fluid was under increased pressure; cell 
count four — all lymphocytes. Culture of the 


Volume Thirty, No. 5 


Acute Hemorrhagic Encephalitis 


95 


fluid showed an isolated Gram positive diplo- 
coccus, which morphologically appeared as 
pneumococci but was not recovered on trans- 
plantation to solid media. Globulin was 
negative (Pandy) ; sugar 90 mg.; chlorides 
725 mg. Gold sol and Kahn were negative. 
Pv. B. C. 4,800,000; W. B. C. 43,100; Hb. 
85% (Dare). Urine showed a slight trace of 
albumen, orange-colored test (Benedict) for 
sugar, and a few hyaline casts. X-ray of the 
chest revealed no pathology. 

A neurologist was had in consultation and 
a diagnosis of encephalitis, probably hemor- 
rhagic in type, was made. Xo importance 
was attached to the urinary sugar nor to a 
later blood sugar of 287 mg., it being felt 
that these phenomena were related to the 
brain pathology and not to a true diabetes. 
(The urine and blood sugar subsequently 
returned to normal.) 

On admission the temperature was 103.6 
F. rectal. The next day it rose to 104.6 and 
the patient appeared moribund. Hypoder- 
moclyses of normal saline, intravenous glu- 
cose and insulin subcutaneously were started. 
Prontosil was given intramuscularly in 5 cc. 
doses every four hours. The next day the 
temperature was 100.0 F. and except for the 
following three days when it rose to 101.0, 
did not go above that point. Daily lumbar 
puncture was done and discontinued as the 
fluid remained consistently negative. W. B. 
C. gradually dropped to 10,050. The patient 
was discharged home in four weeks to con- 
valesce. At the time he was discharged he 
was still disoriented, staggered, and had a 
nystagmus to the left. His wife stated that 
his disorientation was slightly improved, if 
anything, as compared to his condition prior 
to the onset of the present illness. 

Interval History : The patient’s condition 
remained practically unchanged for approxi- 
mately nine months, two of which we had 
him under direct observation. 

Ten days before we saw him again he 
developed what was diagnosed as a mild 
upper respiratory infection, with hoarseness, 
nasal discharge, cough, and temperature. 
After that his wife noticed that when he 
tried to stand his body tilted to the right and 
he had difficulty in standing without assist- 
ance. The temperature varied from normal 
to 101.0 F. When no improvement was noted 


I was asked to see him again and made the 
following physical findings. 

Physical Examination : The patient was 
sitting in a chair, fully dressed, showing 
marked ekorieform movements of both upper 
and lower limbs, apparently partially coma- 
tose. 

Eyes : Pupils were contracted with little 
or no reaction to light. Ophthalmoscopic 
examination showed bilateral choked discs, 
no exudates or hemorrhage. Xystagmus to 
the left. 

Heart, Lungs, Abdomen : Essentially 

negative. 

Xeurological : Xeck stiff, bilateral Babin- 
ski and ankle klonus. Due to condition no 
conclusive or adequate tests for cerebellar 
function could be made. 

A diagnosis of an exacerbation of a chronic 
encephalitis was made and the patient hos- 
pitalized. 

Course at Hospital : On admission lumbar 
puncture was done. The fluid was clear, 
under increased pressure, cell count 3, globu- 
lin slightly positive (Pandy). Urine was 
negative, W. B. C. 20,800. 

Twelve hours after admission the tempera- 
ture rose from normal to 103.2 F. (B.), 
pulse 110, respiration 18. At that time in- 
trathecal prontylin solution prepared accord- 
ing to the specifications of the Winthrop 
Chemical Co. 1 wms instituted. Prontosil in 
5 cc. doses was injected intramuscularly at 
the same time. During the next twelve hours 
the clinical condition appeared very much 
improved. Then the temperature rose to 
105.0 F. In spite of repeated lumbar punc- 
tures, medications, and supportive treatment, 
intracranial pressure gradually increased, 
the respiratory center became affected and 
the patient died 72 hours after admission. 

The spinal fluid became xanthochromic, 
with a large fibrin web, which formed within 
a few minutes. The cell count varied from 
770 to 1,500, and before death was 5,700 — 
mostly band form polymorphs. It is my 
opinion that this change in character of the 
spinal fluid was due in part to chemical irri- 
tation from the intrathecal prontylin. 

Xecropsy: Post-mortem examination was 
done two hours after death and limited to the 
head. 


96 


The Journal of the Maine Medical Association 


Body is tliat of a well-developed, fairly 
well-nourished, white male, apparently 70 
years of age. 

Head was opened by an incision behind 
the ears, carried over the scalp. The scalp 
was reflected, the calvarium sawed through 
and removed. The dura was thickened and 
densely adherent. About 100 cc. of yellow- 
ish, slightly cloudy fluid escaped when the 
dura was incised. 

Surface of brain is markedly swollen and 
tense; the vessels markedly injected. 

Cerebral hemispheres were opened. The 
left lateral ventricle was found slightly 
larger than the right. The third ventricle 
was somewhat distended. On section the tis- 
sue of the right hemisphere is apparently 
normal ; the left shows a replacement by a 
yellowish, white material, grossly taken to be 
gliomatous tissue. 

The convolutions ranged from flattened to 
obliterated. Section of the cerebellum showed 
a similar picture. Section of the medulla 
was grossly normal. 


Diagnosis 


(1) Meningitis. 

( 2 ) Cerebral edema. 

(3) Encephalitis. 

(4) X Atrophy of left side of 
brain. 

(5) X Acute left internal 
hydrocephalus. 


Meuro-pathological Impressions : Over the 
surface were observed several small areas of 
thickened arachnoid and apparently some 
trapped white substance underneath. Ques- 
tion of pus. The whole of the arachnoid was 
definitely more dense than one would nor- 
mally expect. 

There were many pipe-stem vessels. Sec- 
tions cross and longitudinally showed in the 
cut surface what looked like an increase in 
the amount of cut vessel ends, and probably 
free blood throughout the whole brain sub- 
stance. This seemed about equal throughout 
the brain, possibly greater in the basal 
ganglia. Mo gross evidence of tumor found. 
Mo abscess collection. 

Microscopic Report : Edema and neutro- 
philic infiltration of the meninges. (Mo re- 
port received on the pieces of brain tissue 
sent.) 

Diagnosis: Meningitis (acnte). 


Footnote 

i The Winthrop Co. advised using the method 
reported by Schwentker, Gelman and Long — Journ. 
A. M. A., 108 : 1407, April 24, 1937. 

Prontylin (powder form) is used. The required 
amount of 0.7 saline solution is first boiled for 2 
minutes; when the solution cools to 90. C. there is 
added 0.8 gm. of Prontylin for each 100 cc. of 
saline solution. The hot solution is agitated to 
facilitate dissolving of the powder and cooled to 37. 
C. From 10 to 30 cc. may be injected intrathecally, 
but usually 5 to 10 cc. less than is taken out at 
puncture. 


Available Panel Discussion 


The following panel discussions are avail- 
able to County Societies and dates for any of 
them may be arranged by conferring direct 
with the Chairman of the different panels or 
Frederick T. Hill, M. D., The Professional 
Building, Waterville, Maine. 

1. Pneumonia: Frederick T. Hill, M. D., 

Waterville, Chairman. 

2. Cardio- Vascular Diseases : E. E. Holt, 

Jr., M. I)., Portland, Chairman. 

3. Fractures: Allan Woodcock, M. D., 

Bangor, Chairman. 


4. Laboratory Methods and Their Rela- 

tion to Clinical Examination : 
Julius Gottlieb, M. D., Lewiston, 
Chairman. 

5. Acute Appendicitis: F. H. Jackson, 

M. D., Houlton, Chairman. 

6. Cancer : E. H. Risley, M. D., Water- 

ville, Chairman. 

7. Surgery of the Thorax: George E. 

Young, M. D., Skowhegan, Chair- 
man. 


Volume Thirty ; No. 5 


Ragweed Survey in Maine for 1938 


97 


Ragweed Survey in Maine for 1938 

By Charles B. Sylvester, M. D., Portland, Maine 


The survey of ragweed pollen in Maine 
was repeated in 1938 at one station, and four 
new receiving stations were added. 

Owing to the surprisingly low 1937 count 
at Presque Isle, we were eager to check up 
on Aroostook Comity, and Houlton was se- 
lected. The result confirms the accuracy of 
the 1937 count, and establishes the freedom 
of Aroostook County from ragweed. There is 
a present discussion of the ragweed pollen 
incidence in Mew Brunswick and the prov- 
inces, in which comparison with our work in 
Aroostook County is being made by Doctor 
Vander Veer of Mew York. 

A survey of Rockland was completed in an 
effort to tabulate the air content in the 
Penobscot Bay area. This appears to con- 
firm the findings of 1937. With the prevail- 
ing westerly winds, Rockland might have a 
higher pollen count than the coast east of 
Penobscot Bay. It will be noted that, the 
index for 1938 agrees with the index for 
Southport in 1937. 

A survey of Rangeley Lakes was promised 
for this year. As a seasonal count had been 
established at Upper Dam five years ago, we 
were interested in the comparison after years 
of increased seasonal tourist travel and pos- 
sible lessening of forested barriers. Whatever 
reason one pleases to assign, an increased 
ragweed pollen air content was maintained 
for the season from August 10 to September 
28 at Oquossoc. 

The field service of the State Bureau of 
Health also established a reception at the fire 
station on Speckle Mountain, on the Maine 
border to the northwest of Bethel, represent- 
ing the area of mountainous extension from 
the White Mountains. The pollen count, as 
might be expected, was low. 

The survey was repeated at Poland Spring, 
with the reception shelter placed at a lower 
level and less influenced by higher atmos- 
pheric wind currents. The seasonal index 
was considerably lower than the year before, 
and there was no single day’s count so high as 
last year. There was a notable increase of 
pollen on September 21st, the day of the 


hurricane, and there was a less increase at 
Rockland. Apparently the White Mountains 
split the hurricane, the eastern portion being- 
deflected sharply toward the center of Maine, 
where it gradually dissipated. Therefore, the 
pollen receiving stations at Speckle Mountain 
and Oquossoc were protected by the White 
Mountains range. This pollen deposit find- 
ing agrees with the timber destruction path 
in Morth Cumberland and Oxford Counties, 
and emphasizes the importance of the White 
Mountains as storm barriers. 


Station 

Number of 
Hay fever 
Days 

Highest 
Count for 
One Day 

Total 

Count 


Houlton 

1 

27 

57 

i 

Rockland 

5 

62 

526 

8 

Speckle Mountain 

1 

33 

214 

2 

Rangeley 

6 

98 

418 

9 

Poland Spring 

6 

57 

475 

9 


The technic of reception and slide prepa- 
ration, exchange of slides, and laboratory 
counting was identical with that of last year. 
The Bureau of Health furnished supplies 
and took complete care of providing recep- 
tion shelters and collecting all slides. The 
Bureau’s chief and field officers manifested a 
live interest. Hearing that I had denied the 
presence of giant ragweed in Maine, Dr. 
Mitchell of the 2nd district brought “coals to 
Mewcastle” by delivering to me a freshly- 
pulled specimen of matured giant ragweed 
from a vacant lot within the Portland city 
limits. 

Ragweed air pollution is an increasing 
danger to the allergic inhabitants of the state, 
and a menace to the tourist travel business. 
We reaffirm our conviction that ragweed can 
be destroyed and should be destroyed in 
Maine. All the splendid public spirit of gar- 
den clubs, service clubs, and village improve- 
ment associations should be co-ordinated, and 
shoidd lead up to a state-wide elimination of 
th is pest. This large-scale program could be 
proportionately planned at less expense. 

Continued on ■page 101 


98 


The Journal of the Maine Medical Association 


The President’s Page 

To the Members of the Maine Medical Association: 

Now that belated signs of spring are in the air and our long-drawn-out session 
at the Legislature is about to close, our thoughts naturally are drifting toward 
Poland Springs, where our Annual Convention will be held on June 25th, 26th 
and 27th. 

There is every indication that this will be a very happy and instructive occasion. 

I have visited the Poland Spring House, accompanied by our secretary, 
Dr. Carter, and have learned to our own satisfaction that the management is will- 
ing to cooperate in every way with our committees to make this a most successful 
event. 

The commercial exhibits, social functions, conferences, and business and 
scientific sessions will be held under one roof, which is a far different arrangement 
than has been customary in the past. 

Under the direction of Dr. Stephen Cobb, our efficient Chairman of the 
program committee, every minute detail has been considered. The program in 
brief will lie published in the May issue of our Journal, and the complete program 
in the June issue. 

These things all bring to our minds the fact that our Calendar Year is draw- 
ing to a close, for which many of us will be very thankful. 

Our Society has been confronted with many serious problems which have 
demanded much time and effort, but fortunately there have been equally as many 
pleasant occasions ; therefore, let us all get together at Poland Springs in June and 
work for the good of our Society and make this a gala time, long to be remem- 
bered in the history of the Maine Medical Association. 

Willard PI. Bunker, M. D., 

President, Maine Medical Association. 


Volume Thirty, No. 5 


Editorial 


99 


Editorial 

Concerning the Status of Cer tain Hospital Physicians 


If the following statement is advanced as 
one of fact it might be interesting, perhaps 
profitable, to enquire as to the why of such an 
implication. According to Elton (1), “The 
American Hospital Association feels that the 
services of radiologists, physical therapeu- 
tists, anesthetists, cardiologists, pathologists 
and clinical pathologists should be included 
in group hospital projects, since, as has been 
stated in the journals of the Hospital Asso- 
ciation, they cannot be considered practicing 
physicians because They merely carry out 
the orders of practitioners of medicine — are 
subordinates — and assume no responsibility 
to the patient’.” How any hospital can di- 
vorce the important professional services of 
any of the above-mentioned physicians and 
pretend they are fulfilling their obligations to 
their patients is something difficult to under- 
stand. The important question, however, is 
how the inclusion is to be made. 

This problem is one of vital importance. 
Unwise and unjust decisions will surely lead 
to consequences that may be disastrous : to 
the public, to physicians and even to the 
hospitals. The establishing of ethical and 
just standards for physicians holding hospi- 
tal positions, in any scheme of group hos- 
pital projects, is absolutely necessary. Any 
system of group hospital insurance is a con- 
tractural one between the insurers and the 
hospital for “hospital services.” What con- 
stitutes hospital services? As has been em- 
phasized before it is the staff that makes a 
hospital, not a set of ornate and imposing 
buildings, and to deny any member of the 
staff due recognition, exploit his services in 
any way or refer certain studies to a non- 
medical personnel should be met with em- 
phatic objections from the entire profession. 

(1) Journal A. M. A., Vol. 112, Number 9, 869. 


Patients enter hospitals for a certain pur- 
pose. The job of the hospital- — by means 
many times of the combined efforts of the 
entire staff — is to restore a given patient to 
health if it is possible. If that end cannot be 
accomplished legitimate reasons must show 
why. To designate physicians working in 
highly technical and specialized lines, to be 
sure many of them are not in private prac- 
tice and cannot be under the conditions they 
work, as “ancillary” workers in clinical medi- 
cine raises a most important question. If 
they are not practicing medicine wliat are 
they doing? Much of scientific medicine to- 
day is founded on the researches and their 
clinical adaption of pathologists and clinical 
pathologists. It is an admitted fact that in 
many major surgical procedures the anes- 
thetist is a most important member of the 
surgical team. The demands made by many 
of the present-day highly technical surgical 
procedures has required of the anesthetist a 
most exacting preparation for his specialty. 
The modern radiologist is most emphatically 
not a physician who is skilled, merely in the 
“taking of X-ray films.” That indeed is a 
small part of his job and in busy clinics 
technicians properly take over routine work 
of this type. What modern medicine asks of 
the roentgenologist is his interpretation of 
the evidence disclosed by his study of a given 
case. He must be skilled, he must be a phy- 
sician capable of interpreting the evidence 
before him in terms of clinical fact and the 
most of us rely on his judgment and advice ; 
if we have common sense. 

All of these physicians are and must be re- 
garded as colleagues and in no way separate 
and apart from clinical medicine. All physi- 
cians should be grateful that such services are 
at our call ; most of us ARE. 


IOO 


The Journal of the Maine Medical Association 


4.30 P. M. 

Eighty-Seventh Annual Session 
Program in Brief 

Sunday, June 25th 

Golf Preliminaries. 

First meeting of the House of Delegates. 

8.30 P. M. 

Entertainment for the doctors and their wives, by a nationally known presti- 
digitator. 

9.30 to 
12.00 A. M. 

Monday, June 26ti-i 

Conferences. 

12.30 P. M. 

Luncheon. 

Tables will be reserved for reunions of alumni of Boston University, Johns Hop 
kins, Bowdoin, McGill, and Harvard University Medical Schools. 

Golf Preliminaries. 

12.00 to 
2.00 P. M. 

Motion Pictures, Medical. 

2.00 to 
4.45 P. M. 

Clinical-Pathological-Scientific Session. 

5.00 P. M. 

Election of President-elect. 

5.30 P. M. 

Second Meeting of the House of Delegates. 

7.00 P. M. 

Dinner and Dancing. 

9.00 P. M. 

James S. Greene, M. D., New York City, “Speech Defects.” 

9.30 to 
12.00 A. M. 

Tuesday, June 27th 

Conferences. 

12.30 P.M. 

Past Presidents’ and County Secretaries’ Luncheons. 

12.00 to 
2.00 P.M. 

Medical Motion Pictures. 

2.00 to 
5.00 P. M. 

Scientific Session. 
Golf Finals. 

7.00 P. M. 

Banquet (dress informal). 

Introduction of Visiting Delegates and Guests by President Willard H. Bunker. 
Presentation of Fifty-Year Service Medals. 

Guest Speaker: Morris Fishbein, M. D., Editor of the American Medical Jour- 
nal, “American Medicine and the National Health Program.” 


Volume Thirty, No. 5 


Convention Rates 


IOI 


To the Ladies 

Our president’s most genial wife lias taken 
it upon herself to see that we give the women 
an extra break this year. All of the evening 
sessions have been made specially attractive 
for the ladies. There will be dinner dancing 
on Monday evening. Monday and Tuesday 
afternoons there will be bridge parties with 
suitable prizes. Automobiles will be provided 
for a number of sight-seeing trips. We also 
have some fine motion pictures for the women 
who do not play bridge. 


Golf T ournament 

This is our second annual handicap golf 
tournament. Last year, on account of the 
rain, at Bar Harbor, we had only a few con- 
testants. Doctor Forrest Tyson of Augusta, 
Maine, has promised to take care of the run- 
ning of the tournament. 

We can assure you that the course is one 
of the best, and the prizes are well worth the 
fun and effort. 


Convention Rates 

Poland Spring House 
Poland Spring, Maine 

The following Room Rates, which include all meals, will prevail : 

Single Rooms without bath $6.00 per day 

Double Rooms without bath 6.00 per day, per person 

Double Room and Single Room with connecting bath, for 3 persons 7.00 per day, per person 

Two Double Rooms with connecting bath for 4 persons 7.00 per day, per person 

Double Room with bath for 2 persons 7.00 per day, per person 

Single Room with bath S.00 per day, per person 

tennis courts and Beach Club will be avail- 
able without charge. 

The Hotel Orchestra will be available four 
hours each day for dancing. 

Poland Spring Water , both Natural and 
Carbonated, will be served at all times to the 
guests of the Hotel. 


The charge for non-registered guests for 
meals will be as follows : 


Breakfast $1.50 

Luncheon 2.00 

Dinner 2.50 


Golf green fees will be $1.00 per day. The 


Continued from page 97 


In proof of our statement of the 1937 sur- 
vey in Aroostook County : “Most soils, if not 
made to produce crops, will produce rag- 
weed ; it is evident that soils, like human 
beings, should be kept busy”, read the very 
comprehensive illustrated story of pollens by 
Director R. P. Wodeliou9e of the Hayfever 
Laboratory at Yonkers, A. Y., in the March, 
1939, Natural History Magazine: 


“The increase of ragweed hayfever in the 
United States results from more denuded 
soil. . . . Nature demands that land be 
clothed. If we do not like her choice of 
weeds, we may select our own. . . . Let land 
revert to forest which kills out ragweed, or 
cultivate intensively. . . . Waste means weeds 
and hayfever.” 


102 


The Journal of the Maine Medical Association 


Committee Reports 


Legislative Committee 

To the Officers and Members of the Maine 
Medical Association: 

The Legislative Committee wishes to sub- 
mit the following report for the year 1938- 
39: 

It was necessary to call two full meetings 
of the Legislative Committee,- — one at the 
Augusta House in January, at which time 
only two members were absent. 

The second meeting was held at the Wors- 
ter House at Hallowed on the evening of Feb- 
ruary 8tli with an equally good attendance. 

At our January meeting a goodly store of 
bills appeared to be lining up for the term of 
Legislature at Augusta and it was voted that 
with the approval of the Council a stipulated 
sum should be paid our attorney, Mr. Her- 
bert E. Locke, and that as far as possible he 
would represent the Maine Medical Associa- 
tion at the Legislative Term in Augusta in 
opposing any bills proposed at that session 
that appeared unjust. 

It was also voted at the January meeting 
that members of our Association avoid ap- 
pearing before the Legislature unless at the 
request of Mr. Locke. 

A committee consisting of three members 
was appointed for the purpose of consulting 
freelv with Mr. Locke on all legislative mat- 
ters and this arrangement has proven very 
satisfactory. 

Among the numerous questions that have 
confronted us I might mention the Medical 
Examiners’ Bill, the Osteopathic Bill, the 
Uniform Narcotic Drug Act, the Maternity 
and Obstetrical Act, the Barbital Bill and 
the Bill on Nursing Requirements. 

The Legislature is still in session and all of 
these bills have not been disposed of but it is 
indeed gratifying to report that the final 
results will be most satisfactory. 

The Legislative Committee wishes to ex- 
tend their thanks for the hearty cooperation 
of the Maine Hospital Association, Maine 
Nursing Association, and many of our mem- 


bers throughout the State who were not 
directly connected with this committee. 

It has indeed been a difficult vear but due 
to our unity of purpose and perseverance we 
feel duly repaid and that our time and energy 
have not been spent in vain. 

Respectfully submitted, 

Willard H. Bunker, 

Chairman, 


Cancer Committee 

A review of the activities of the Cancer 
Committee reveals evidence of individual 
and collective cooperation, rather than separ- 
ate endeavor of the Committee as a function- 
ing unit. In other words, the work of the 
members of the Cancer Committee has been 
so closely tied up with the public activities 
of the Women’s Field Army for the Control 
of Cancer, that there has been little room for 
other projects by the Cancer Committee as 
such. 

However, it would seem that this particu- 
lar method of presenting constructive Cancer 
work has not been without definite evidence 
of progress. 

The educational campaign of the Women’s 
Field Army has been eminently successful. 
To this campaign various members of the 
Cancer Committee have contributed much in 
personal time and effort. Speaking before lay 
groups and by radio, the medical aspects of 
cancer have been frequently presented. Posi- 
tive results of this campaign have been noted 
in the steadily increasing number of individ- 
uals who have visited the Tumor Clinics for 
advice and treatment. 

No new Tumor Clinics have been added 
during the past year. The list is made up as 
follows : 

Central Maine General Hospital, Lewiston. 

Eastern Maine General Hospital, Bangor. 

Maine General Hospital, Portland. 

Sister’s Hospital, Waterville. 

St. Mary’s General Hospital, Lewiston. 

Thayer Hospital, Waterville. 


Volume Thirty ; No. 5 


Committee Reports 


103 


Publicity Committee 


Members of the State Cancer Committee 
have served as Clinic personnel, along with 
other members of the institutional staff. 

Figures from the office of the Women’s 
Field Army show that the Joseph W. Scan- 
ned Memorial Fund was exhausted October 
1, 1938, so great was the increase in demand 
for services to the indigent. Benefits from 
this fund were widely distributed through- 
out the State. 

The question has been brought up of pla- 
cing other diagnostic clinics at strategic 
points in the State not now easily covered. 
These would serve to lighten the load on some 
of the larger centers. A study of this prob- 
lem is now going on and key men are being 
contacted with the idea of inaugurating such 
diagnostic centers. 

Because of the requirements of high-volt- 
age roentgen therapy and radium, only the 
larger clinics are likelv to carry on the tliera- 
peutic measures of radiation. 

Early in the year a symposium on cancer 
was prepared by a committee member, Ed- 
ward H. Risley, M. D., of Waterville, I)r. 
Risley acting also in his capacity as Chair- 
man of the Advisory Board of the Women’s 
Field Army. Contributions to this sympo- 
sium were made by members of the State 
Association Cancer Committee and other 
medical members of the Women’s Field 
Army Advisory Board. Under appoint- 
ment, requested by the Committee on Grad- 
uate Education, Dr. Risley plans to offer this 
Symposium for panel presentation at County 
Medical Society meetings. 

In review it may be stated that cancer 
work in the State of Maine is much more 
active than it has been for years. The educa- 
tional activities of the Women’s Field Army 
for the Control of Cancer, backed by the 
personal and professional cooperation of 
members of the Maine Medical Association, 
are helping the laity, as a whole, to become 
more and more cancer-conscious. The biggest 
problem now seems to be to synchronize the 
educational work with funds available for 
carrying the increasing load of indigent pa- 
tients, seeking treatments for cancer. 

Forrest B. Ames, M. D., 
Chairman Cancer C ommittee, 
Maine Medical Association. 


To the Officers and Members of the Maine 
Medical Association: 

The Chairman of the Publicity Committee 
reports that the only official releases for 
newspaper publication during the year were 
the notices and programs of the Clinical Ses- 
sion held in Lewiston during November, 
1938. 

The Chairman wishes to take this oppor- 
tunity to advise members that the Council 
believes that the best interests of the Associa- 
tion require that an authorized committee 
assume the responsibility for the newspaper 
publication of any organization affairs. 

Respectfully submitted, 

Thomas A. Foster, M. D., 

Chairman. 


C ommittee on Graduate 
Education 

To the Officers and Members of the Maine 
Medical Association: 

The Committee on Graduate Education 
respectfully submits the following report : 

One of the most important responsibilities 
facing State Medical Associations is that of 
providing an adequate program of Graduate 
Education. The problem varies in different 
States, due to many local factors. Conse- 
quently there is bound to be considerable 
variation among the several programs which 
are being developed. A permanent organiza- 
tion of the different State Committees on 
Graduate Education has been effected, for 
mutual benefit and exchange of ideas. Your 
chairman has attended each meeting of this 
central organization and plans to be present 
at the next meeting in St. Louis at the time 
of the meeting of the American Medical 
Association. 

Your committee has had several meetings 

O 

during the year and has been in conference 
with the Council and the County Secretaries. 

Because of the unique advantage accruing 
to our State through the Bingham and the 
Commonwealth Fellowships our program 
naturally becomes divided into two parts : 
one, intramural, concerned with making 


The Journal of the Maine Medical Association 


104 


available adequate educational programs 
within our State ; and the other, with the 
wider utilization by our members of courses 
available in Boston. 

It was decided to develop our intramural 
program in conjunction with the County 
Societies. After some experimentation, in an 
endeavor to find the most interesting type of 
program, a series of Panel Discussions were 
prepared and offered to the different County 
Societies. Panels on the following subjects 
are now available : “Pneumonia,” “Cardio- 
vascular Disease,” “Fractures,” “Acute Ap- 
pendicitis and Complications,” “Laboratory 
Methods and Their Application in Clinical 
Medicine,” “Surgery of the Thorax” and 
“Cancer.” It is expected that panels will be 
developed upon other subjects from time to 
time, depending upon the demand. So far 
this type of program has seemed very popular 
and worthwhile. 

Your committee has cooperated with the 
Directors of both the Bingham and the Com- 
monwealth Funds in an endeavor to have the 
available Fellowships allocated where most 
needed. For the most part these Fellowships 
hithertofore have been designed for men 
practicing in the smaller communities. As 
near as can be estimated about 15% of our 
membership have taken advantage of these 
Fellowships. Perhaps another 10% have 
been providing their own educational pro- 
gram, independently — through long-estab- 
lished hospital or society affiliations — and 
need not enter into the problem. 

Of the remaining 75%, eliminating the 
men near retirement age, there must be about 
50% who should have available, facilities for 
some form of Graduate Study. An intra- 
mural program is essential in order to reach 
these. In turn this may stimulate interest in 
some phase of our extramural program. At 
present it does not seem necessary to further 
expand our program but rather to coordinate 
and develop what we already have. The sole 
exception to this might be where, in certain 
counties, such as Aroostook, the geographical 
problem makes it difficult for men to attend 
meetings, especially during the winter. Here 
it might be well to consider the question of 
intensive intramural courses — to be given 
during the summer. If there be sufficient 


local interest, such a program can be devel- 
oped and financed without expense to the 
local groups. It is understood that the Bing- 
ham Associates are developing another form 
of Fellowship, giving short, intensive courses 
of one week’s duration and covering more 
concrete subjects. These will provide study 
on more specialized subjects than hitherto- 
fore available and should appeal to a greater 
number of our members. 

Recommendations : 

(1) Greater coordination between the 
programs of the Annual June Meeting and 
the Fall Clinical Session, and the program 
of Graduate Education. While there is no 
desire to interfere with the committees hav- 
ing in charge these two annual events, the 
Committee on Graduate Education necessar- 
ily must have a long-range viewpoint, and 
cooperation between these committees might 
result advantageously for all concerned. 

(2) Continuation of the Panel Discus- 
sion type of program — through the County 
Societies. 

(3) Further development of the Hospital 
Staff program, utilizing the material avail- 
able for case study. “Education Should Be- 
gin at Home.” 

(I) Participation of the State Associa- 
tion as an organization in the Hew England 
Post-Graduate Medical Assembly. This has 
already proved its usefulness and is a “going 
concern.” It offers a great deal in the way 
of Graduate Education. 

(5) Cooperation with the Bingham and 
the Commonwealth Funds in the extramural 
program — through greater utilization of the 
available Fellowships. Courses on any de- 
sired subjects may be obtained for groups of 
four men — through application to the Com- 
mittee. 

Respectfully submitted, 

Frederick T. Hiel, M. D. 

Julius Gottlieb, M. D. 

Norman H. Nickerson, M. D. 

Frank H. Jackson, M. D. 

Eugene E. Holt, Jr., M. D. 


Volume Thirty, No. 5 


Committee Reports 


105 


Advisory Committee on 
Syphilis Control 

To the Officers and Members of the Maine 
Medical Association: 

The Committee presents the following re- 
port received from Roscoe L. Mitchell, M. D., 
Assistant Director of the State of Maine De- 
partment of Health and Welfare. 

State of Maine 
Venereal Disease Statistics 

Calendar Year 1938 

“During the year the director of the divi- 
sion gave 36 lectures mostly to lay persons 
on the subject of venereal disease, the total 
attendance being about 3,300 persons. About 
800 pieces of educational literature were sent 
ont in response to requests. 

The Diagnostic Laboratory performed 
19,080 Kahn tests and 17,658 Hinton tests. 
Examinations for the presence of gonococci 
totalled 5,827, 1,162 of these being per- 
formed at the Branch Laboratory in Caribou. 

Mo record is available of the amount of 
treatment for syphilis given by private phy- 
sicians. The Bureau of Health receives re- 
ports from the twenty-seven state clinics and 
their totals for the year 1938 list 11,846 
doses of arsenicals and 12,948 doses of heavy 
metals. 

During 1938, 58% of the newly reported 
cases of syphilis were attending the clinics, 
whereas 60% of the new cases of gonorrhea 
were being treated by private physicians. 


Case reports give a total for 1938 of 588 
cases of gonorrhea, 487 being acute, 90 
chronic and 11 not stated. Of syphilis 572 
were reported, the stages being as follows : 
95 primary; 139 secondary; 289 tertiary; 36 
congenital ; 8 latent and 5 not stated. 

Free drugs of all sorts were issued by the 
Bureau to 130 physicians during the year 
1938, exclusive of the material furnished to 
the state clinics.” 

Ben.jamix B. Foster, M. D., 

Chairman. 


Report for the Committee on 
the Prevention and Amelio- 
ration of Deafness 

The outstanding accomplishment to be re- 
ported for the year is that of the purchase, 
by the Bangor School Department, of an 
audiometer for mass testing and final testing 
of school children. 

This move will make it possible for the 
surrounding communities to have the use of 
an audiometer, also, at a very normal charge. 

It is felt that this move will be a step for- 
ward in remedial and preventative care in 
another section of the state. 

Harry Butler, 

Chairman. 


Cancer Notes 


A recent report from the Mayo Clinic of 
six cases of Hodgkin’s disease localized in the 
stomach again calls attention to a diagnostic 
problem of interest to surgeon and patholo- 
gist alike. The relatively infrequent accounts 
in the literature doubtless undervaluate its 
actual occurrence. Many cases diagnosed as 
inoperable gastric carcinoma without biopsy 
or operation fall under this heading, as well 
as occasional cases classified by the patholo- 


gist as atypical carcinoma or lymphosarcoma. 
— Seaton Sailer, M. D., The Southern Sur- 
geon, Dec.. 1938. 


It is recognized that any woman manifest- 
ing abnormal uterine bleeding should have a 
diagnostic curettage. — Dr. K. C. Morrin 
and Dr. Paul F. Max, in Surgery, Gy nee. 
Obs., Jan., 1939. 


The Journal of the Maine Medical Association 


106 


Maine Medical Legislation 
1939 Maine Legislature 


1. Original L. D. 873. Hospitals must admit to 
practice in them osteopaths and must do all 
laboratory work required by osteopaths. Killed 
in the last week of the session. 

2. Original L. D. 22. Dr. Pratt’s amendment to 

Medical Examiners’ Bill. Finally passed in the 
last week of the session after a very stormy 
career. Essential changes: Number reduced 

to two each in the counties of Franklin, Han- 
cock, Knox, Lincoln, Piscataquis, Somerset, 
Sagadahoc and Waldo; three each in Oxford 
and Washington: four each in Aroostook, Ken- 
nebec and York; five in Androscoggin; six in 
Cumberland and Penobscot. Governor may ap- 
point as many more as he considers advisable, 
repealed. But law not to take effect until Jan- 
uary 1, 1941, i. e., after present Governor re- 
tires from office. Consequently, present Gov- 
ernor will not be embarrassed by failure to 
reappoint. 

3. Original L. D. 581. Sale of opium derivatives 
only on prescription. Passed. 

4. Original L. D. If72. Sale of barbituric acid 
derivatives or compounds only on prescription 
(except for personal administration by a doc- 
tor, dentist or veterinary to his own patients). 
Passed. 

5. Original L. D. 820. Dispensation of marijuana 
forbidden. Did not jrass. 

6. Original L. D. 87 If. Hospitals (and inferen- 
tially others) may charge only $3.00 each for 
X-ray pictures. Did not 

7. Original L. D. 880. United States Uniform 
Narcotic Law. Did not j)ass. 

8. Original L. D. 1/71. Requiring pre-marital ex- 
amination for venereal diseases. Amended to 
require merely a prenatal examination. Re- 
quires every physician to take during gesta- 
tion a blood test and submit to the State Lab- 
oratory. Rushed through in this last amended 
draft during the last week of the session. Got 
it recalled from Governor’s office and had the 
words added, “and no civil action shall be main- 
tainable for failure to comply with this act.’’ 
Reason: The law says a doctor must take the 
blood test of the patient. Of course, this won’t 
be done in many instances. To be sure, the 
consent of the patient is required. But in mak- 
ing a malpractice claim, the patient could and 
from previous experience in some instances 
would claim that she gave the consent. That 
the doctor had not taken the test which the 
law demands could well be claimed to be mal- 
practice. Consequently, this amendment to 
avoid malpractice suits. 


9. Original L. D. 606. Lien on casualty insurance 
proceeds for hospitals. Did not jrnss. 

10. Original L. D. 57. Creating office of State 
Pathologist, earnestly supported by attorney- 
general. Did not pass. 

11. Original L. D. 537. Compensation Act. Em- 
ployee may select his own physician in indus- 
trial injury. Did not pass. 

12. Original L. D. 612. Non-profit hospital corpora- 
tions authorized. Did pass. 

13. Original L. D. 938. Boards of registration, in- 
cluding that of medicine, may suspend the 
license fees if and whenever there is enough 
money on hand to warrant it. Did pass. 

14. Original L. D. 322. Incorporating the Associ- 
ated Hospital Service of Maine (Socialized 
Hospital Service). Did jrass. 

15. Original L. D. 600. Optometrist Bill. — Forbid- 
ding optometrists to practice when hired out, 
as to chain stores. Passed. Stormy career and 
in doubt up to the last end of Legislature. But 
probably ineffective for the purpose it seeks. 
Because the stores employing the optometrist 
will have written contracts with them and 
probably can by injunction and in equity pre- 
vent the operation of the law to defeat their 
rights under the written contracts. 

16. Original L. D. 755. To create a licensing de- 
partment in the hands of one man to take over 
completely all the powers of the various 
boards of registration including medicine. 
Did not pass. 

17. Original L. D. 811. Permits blood-grouping 
tests in bastardy cases and makes the testi- 
mony of examining physician admissible. 
Heretofore such evidence unacceptable in 
Maine courts. Passed. 


18. Original L. D. 51/6. Commitment may be made 
of insane not only to State hospitals as here- 
tofore but to the Government hospitals as 
well. Passed. 


19. Original L. D. 1152. Law suits to recover for 
so-called “death without conscious suffering.” 
Right to recover “the reasonable expense of 
medical, surgical and hospital care and treat- 
ment” added. Bill passed. Heretofore in so- 
called “instant death” cases, i. e., wherein the 
deceased never recovered consciousness after 
the injury, any such incidental expense could 
not be recovered. 


Volume Thirty, No. 5 


County News and Notes 


107 


County News and Notes 


Cumberland 

A meeting of the Cumberland County Medical 
Society was held Friday, April 21, 1939. 

The following cases were presented at a Clinic 
at the Maine General Hospital at 4.30 P. M.: 

“Tri-malleolar Fracture” — William L. Casey, 
M. D. 

‘‘Transient Visual Disturbance during Diabetic 
Regulation” — E. R. Blaisdell, M. D. 

“Diagnostic Problem” — Harold M. Cutler, M. D. 

“Pituitary Tumor” — Thomas A. Foster, M. D. 

Dinner at the Eastland Hotel at 7.00 P. M. was 
followed by a brief business meeting at which 
G. A. Pudor, M. D„ and Charles B. Sylvester, M. D„ 
were proposed for Honorary Membership. The ap- 
plications of Gordon N. Johnson, M. D., Portland, 
and Philip Gregory, M. D., Boothbay Harbor, were 
referred to the Council for consideration. 

Richard H. Overholt, M. D„ of Boston, was the 
speaker of the evening. Dr. Overholt’s subject was 
“Some New Developments in the Management of 
Chest Lesions.” 


Kennebec 

A meeting of the Kennebec County Medical As- 
sociation was held at the Gardiner General Hospi- 
tal on Thursday, April 20, 1939. 

Clinical Session at 5 P. M., which was presided 
over by Leon D. Herring, M. D., President. 

(1) A case of laryngeal edema — A. C. Hurd, 
M. D. 

(2) A case of persistent jaundice — M. D. Shel- 
ton, M. D. 

(3) Ablatio placenta — I. E. McLaughlin. M. D. 

(4) Two cases of intussusception — F. B. Bull, 
M. D. 

(5) A case of Buerger’s Disease — C. R. Mc- 
Laughlin, M. D. 

(6) Metastasis Malignancy — C. R. McLaughlin, 
M. D. 

(7) Premature Separation of Placenta; Caesa- 
rian Operation — S. H. Kagan, M. D. 

Dinner at G.30 P. M., followed by a business 
meeting. 

Minutes of the last meeting were read and 
approved. 

The application of Nathan Rosenberg, M. D., 
Togus, Maine, was received and referred to the 
Board of Councillors. 

The speaker of the evening was Samuel A. 
Levine, M. D., F. A. C. P., Assistant Professor of 
Medicine, Harvard Medical School; Associated 
with Peter Bent Brigham Hospital, Newton Hospi- 
tal, and New England Baptist Hospital. Dr. 
Levine’s subject was “Ausculation of the Heart.” 
He discussed different murmurs, arrhythmias, 
pulsus alternans, and tachycardias. He empha- 
sized the use of the right type of stethoscope, stat- 
ing that certain murmurs could be heard best with 
the bell-type and others with the flat chest piece. 
The address was ably presented and a great deal 
of discussion followed. 

There were 41 members and guests present. 

Respectfully submitted, 

Frederick R. Carter, M. D., 
Secretary. 


Hancock , Knox , Waldo , 
Joint Meeting 

A joint meeting of the Hancock, Knox and Waldo 
County Medical Societies was held at the Windsor 
Hotel, Belfast, on March 23rd. 

Following the banquet, the Waldo County 
Society held a brief business session, with the 
President, Dr. F. C. Small, in the chair. The 
following officers were elected for 1939 : 

President, E. L. Stevens, Belfast. 

Vice-President, G. F. Miller, Belfast. 

Secretary-Treasurer, R. L. Torrey, Searsport. 

Member of Board of Censors for three years, S. C. 
Pattee, Belfast. 

Delegate to the Maine Medical Association 
Annual Session, F. C. Small, Belfast. 

Alternate, C. H. Stevens, Belfast. 

The scientific program consisted of a panel dis- 
cussion of fractures, sponsored by the Committee 
on Graduate Education, and under the chairman- 
ship of Dr. Allan Woodcock of Bangor. 

Dr. Woodcock spoke on general considerations of 
fractures. 

Dr. F. B. Ames of Bangor on the X-ray angle of 
fractures. 

Dr. C. C. Corson of Portland on fractures of the 
spine. 

Dr. W. V. Cox of Lewiston on skull fracture and 
head injuries. 

Dr. Howard Hill of Waterville on eye-ground 
findings in head injuries. 

Dr. C. H. Stevens of Belfast on fractures of the 
hand. 

All the papers were interesting and were well 
received, and a general discussion followed. 

Twenty-six physicians were present, represent- 
ing Portland, Belfast, Waterville, Lewiston, Ban- 
gor, Rockland, Camden, Thomaston, Bar Harbor, 
Ellsworth, Southwest Harbor and Searsport. 

Raymond L. Torrey, M. D., 
Secretary, Waldo County Medical Society. 


York 

Report of the Quarterly Meeting of the York 
County Medical Society. 

The regular April meeting was held on the 12th 
at the Kennebunk Inn. Dinner was served at 1 
P. M.; the meeting followed, with twenty-two mem- 
bers and four guests present. 

The meeting was opened by President Mayo, and 
the following business was transacted: 

Minutes were read and approved. 

Dr. Richards’ application for membership was 
accepted. 

The Committee appointed to take charge of the 
Summer Meeting were: Doctors Cobh, Hill, Jr., 

Dolloff, and Kinghorn. It was decided to accept 
the invitation from the Cumberland County Society 
to join them for that meeting. 

The Committee appointed for the October meet- 
ing were: Doctors E. M. Cook, MacDonald, G. Smith, 
and Kinghorn. It is to he held at York Harbor, 
Maine, at the Hillcroft. 


108 


The Journal of the Maine Medical Association 


Dr. Foster of Portland talked on the condition of 
the two Societies. Dr. Foster is Councillor for the 
First District. 

Dr. Pepper, District Health Officer, made a few 
remarks and offered to answer any questions. 

Dr. Cobb, Chairman of the Program Committee 
for the State Convention, gave a resume. 

Dr. Dolloff read a very interesting letter in 
regard to the outcome of the Aroostook County 
controversy. 

Dr. Corson of Portland lectured on Emergency 
Treatment of Fractures, followed by a film on First 
Aid regarding the topic. 

Dr. Kinghorn showed some interesting slides on 
ear conditions. 

C. W. Kinghorn, M. D., Secretary. 


New Members 

York 

Carl E. Richards, M. D„ Alfred. 


Removal Notice 

Ralph Heifetz, M.D., announces his removal 
from 712 Congress Street, Portland, to 717 Congress 
Street, Portland. 


Important Coming Meetings 


American Medical Association 

American Medical Association, St. Louis, 
May 15-19, 1939 


State Medical Associations 

Connecticut State Medical Society, New Haven, 
May 25-26. Creighton Barker, 258 Church 
Street, New Haven, Connecticut, Secretary. 

Maine Medical Association, Poland Springs, June 
25-26-27. Frederick R. Carter, 22 Arsenal 
Street, Portland, Maine, Secretary. 

Massachusetts Medical Society, Worcester, June 

6- 7-8. Alexander S. Begg, 8 Fenway, Boston, 
Massachusetts, Secretary. 

New Hampshire Medical Society, Manchester, June 
8-9. C. R. Metcalf, 5 S. State Street, Concord, 
New Hampshire, Secretary. 

Rhode Island Medical Society, Providence, June 

7- 8. Guy W. Wells, 124 Waterman Street, 
Providence, Rhode Island, Secretary. 

Vermont State Medical Society, Burlington, 1939. 
Benjamin F. Cook, 46 Nichols Street, Rutland, 
Vermont, Secretary. 


American Congress on Obstetrics and 
Gynecology C ommittee on Maternal 
and Infant Welfare 

The American Congress on Obstetrics and Gyne- 
cology is sponsored by the American Committee on 
Maternal Welfare. This Committee is composed of 
member organizations, with a representative from 
each forming the Board. The member organiza- 
tions include the various national and sectional 
obstetrical and gynecological associations, hospital 
associations, public health organizations, and nurs- 
ing associations. 


The Central Association on Obstetrics and Gyn- 
ecology proposed an American Congress on Obstet- 
rics and Gynecology to study the present-day 
problems on obstetrics and gynecology and their 
solution. The American Committee on Maternal 
Welfare was asked to sponsor this Congress. The 
Congress will be held in Cleveland, Ohio, Septem- 
ber 11 to 15, 1939. The Committee expresses the 
purpose of the Congress, “To present a program of 
our present-day medical, nursing, and health prob- 
lems, from a scientific, practical, educational, and 
economic viewpoint as far as they relate to human 
reproduction and maternal and neonatal care.” 
This Congress is not in any sense a legislative 
body and naturally will take no action relative to 
maternal and infant care. 

There will be sessions for each professional 
group in the morning, with round-table discussions. 
The afternoon meetings will have papers of general 
interest to all members attending the Congress. 
The public will be invited to the evening sessions, 
where there will be speakers of national prom- 
inence. 

The program for the physicians will include 
among many others such subjects as pregnancy 
associated with: thyroid disease, heart disease, 

diabetes, tuberculosis, nutritional factors, carci- 
noma of the female genitive tract, and abortions. 

The Congress is not planned as a meeting for 
specialists in any sense of the word, but for all 
physicians who are interested in the problem of 
maternal and child welfare. Your Committee 
highly recommends this Congress as a week of 
postgraduate work which should be worth while 
much more to the physician than the time and 
expense incurred for the trip. The physicians of 
this State should be well represented at this 
Congress. 

The membership fee of $5.00 includes member- 
ship in The American Committee on Maternal 
Welfare and registration in The American Con- 
gress on Obstetrics and Gynecology. Application 
blanks and further information may be secured 
from your chairman, Roland B. Moore, M. D., Port- 
land, Maine, or from The American Congress on 
Obstetrics and Gynecology, 650 Rush Street, Chi- 
cago, Illinois. 


Volume Thirty, No. 5 


Necrologies 


109 


Necrologies 


Edson S. Cummings, M. D., 

1875-1939 

The State of Maine, as well as the City of Port- 
land and the medical societies, have lost a valued 
friend and helper in the death of Doctor Edson S. 
Cummings. He was born in Lewiston, Maine, De- 
cember 7, 1875, and died at his home in Portland, 
April 11, 1939. He received his early education in 
Lewiston and graduated from Bowdoin Medical 
School in 1900. He interned at the Central Maine 
General Hospital, afterward entering general prac- 
tice in Lewiston. He was on the active staff of the 
Central Maine General Hospital until he entered 
the World War. 

During the World War Doctor Cummings was 
stationed at Camp Funston, Fort Riley, Kansas, 
being in charge of the X-ray work at the hospital 
there, following special work at the Military 
School of Roentgenology at Kansas City, Mis- 
souri. He was on duty at Fort Riley until Janu- 
ary 8, 1919, when he was honorably discharged, 
holding the rank of captain at that time. 

On his return to Maine he located in Portland, 
where he has been in active practice since. For 
twenty years he was on the staff of the Maine Eye 
and Ear Infirmary. 

Doctor Cummings was one of the founders of the 
Medical Research Club of Lewiston and took an 
active part in the County and State Associations. 
He was a member of the Maine Medical Associa- 
tion and the American Medical Association. He 
was also a member of the Masonic Order, Kora 
Temple, Order of the Mystic Shrine, the Portland 
Lions Club, and was active in the Medical Reserve 
Corps. 

Our heartfelt sympathy goes to his wife, Harriet, 
and his son Philip. 


Gilbert M. Elliott, M. /)., 

1867-1939 

Doctor Elliott, who practiced medicine in Bruns- 
wick nearly half a century, died at Brattleboro, 
Vermont, April 1, 1939. 

Born in New York City, March 26, 1867, he was 
graduated from the City College of New York in 
1886, received his degree of Doctor of Medicine 
from Columbia University in 1889 and the degree 
of Master of Science from the City College of New 
York in 1890. On August 13, 1890, he married 
Miss Belle Vennard Merryman, of Brunswick, who 
survives him. 

Doctor Elliott began the practice of medicine in 
Brunswick in 1892. After four years he went to 
Europe and studied at Vienna and Munich, re- 
turning to Brunswick in 1900. He served Bruns- 
wick for many years on the board of health and 
for twenty-seven years was a member of the school 
committee. 

Doctor Elliott held the rank of first lieutenant 
and assistant surgeon in the First Maine Infantry 
during the Spanish-American War, when he was 
assigned to the divisional hospital at Chicamauga. 
He was in charge of the hospital train that re- 
turned to Maine ahead of the troop trains. He 
gradually advanced to the rank of major in the 
National Guard and was transferred to the Medi- 
cal Corps, being in charge of the medical unit of 
the Maine National Guard, which was on duty in 
Halifax following the explosion in 1917. During 
the World War he was assigned to the Bowdoin 
College unit as medical officer in charge of infan- 
try training. He retired from the Maine National 
Guard a few years ago with the rank of Lieutenant 
Colonel. 

Doctor Elliott was a member of the Maine Medi- 
cal Association, the Association of Military Sur- 
geons, the Association of American Anatomists, 
Spanish-American War Veterans, and American 
Legion. 

Surviving, besides his wife, are a son, Gilbert M. 
Elliott, Jr., of Portland, and a daughter, Mrs. 
William D. Ireland of Massachusetts. 


no 


The Journal of the Maine Medical Association 


Correspondence 

Robert E. Jewett, M. D., 

Chairman, 

May Day Child Health Committee. 

Dear Dr. Jewett: 

In connection with the splendid program that is being developed for May Day in protection of the 
lives and health of mothers and children, we should not forget that, in the State of Maine, we still have 
a problem that must be given special consideration. 

During 1938 we had almost three times as many deaths from diphtheria as we had in 1937. We have 
also had more cases of diphtheria. Let us, then, urge all parents to have their children protected at once 
so that, when the incidence of diphtheria begins its seasonal rise in the fall, they may be happy to know 
that their children have been guarded against this dread disease. 

I would appreciate it if you would keep this in mind when developing your publicity program. 

Sincerely yours, 

(Signed) Roscoe L. Mitchell, M. D., 

Assistant Director of Health. 


Book 

“The Vaginal Diaphragm— Its Fitting and 
Use in C ontraceptive Technique ” 

By Le Mon Clark, M. S., M. D., Chicago, 111. Au- 
thor of “Sex Education’’ and “Emotional Adjust- 
ment in Marriage.” 

Published by the C. V. Mosby Co., St. Louis, Mo., 
1939. Price, $2.00. 

In this small, well-illustrated monograph the 
author attempts to give full instructions for the 


Review 

execution of the technique of contraception by the 
combination employment of the flat spring hemi- 
spherical vaginal diaphragm and vaginal jelly or 
cream. Apparently the author’s intentions were to 
instruct the patient in how she can best serve her- 
self after her physician has correctly fitted her 
with the anatomically most appropriate size of 
diaphragm. It is claimed that those who follow 
the author’s instructions will find the method re- 
liable and the technique convenient and reasonably 
clean. 


An effective treatment for 

TRICHOMONAS VAGINITIS 


An effective treatment by Dry Powder Insufflation to be sup- 
plemented by a home treatment (Suppositories) to provide 
continuous action between office visits. Two Insufflations, 
a week apart, with 12 suppositories satisfactorily clear up 
the large majority of cases. 

JOHN WYETH & BROTHER, 'INC. • PHILADELPHIA, PA. 



SILVER PICRATE — a crystalline compound of silver in definite chemical 
combination with Picric Acid . Dosage Forms: Compound Silver Picrate 
Powder — Silver Picrate Vaginal Suppositories. Send for literature today. 

STL V ER PICRATE * QYi/elk • 



OFFICIAL ROSTER 


OFFICERS AND MEMBERS 

OF THE 

MAINE MEDICAL ASSOCIATION 



112 


The Journal of the Maine Medical Association 


Officers and Members 


ANDROSCOGGIN COUNTY 


President 

Vice-President 

Secretary-Treasurer 


OFFICERS 
L. P. Gerrisii, 

John C. Cart land, 
Wedgwood P. Webber, 


Lisbon Falls 
Auburn 
Lewiston 


MEMBERS 


Andrews, S. L., 

Lewiston 

Marian, Joseph C., 

Lewiston 

Beeaker, Vincent, 

Lewiston 

Marston, E. J., 

Auburn 

Beliveau, Bertrand, 

Lewiston 

Miller, Hudson R., 

Auburn 

Beliveau, Romeo A., 

Lewiston 

Morin, R. J., 

Lewiston 

Bernard, Romeo A., 

Lewiston 

Murphy, D. Jerome, 

Lewiston 

Bolster, William W., 

Lewiston 

O’Connell, George B., 

Lewiston 

Brien, Maurice, 

Lewiston 

Parrella, L. A., 

Lewiston 

Buker, Edson B., 

Auhurn 

Peaslee, Clarence C., 

Auburn 

Busch, John J., 

Mechanic Falls 

Pelletier, Anthony, 

Lewiston 

Call, Ernest V., 

Lewiston 

Pelletier, Joseph J., 

Lewiston 

Caron, Frederick J., 

Lewiston 

Peters, Anthony E., 

Auburn 

Cartland, John E., 

Auburn 

Pierce, Edwin F., 

Lewiston 

Chaffers, William H., 

Lewiston 

Plummer, Albert W., 

Lisbon Falls 

Chenery, Frederick L., Jr., 

Monmouth 

Pratt, Harold S., 

Livermore Falls 

Chevalier, Paul, 

Lewiston 

Rand, Carlton H., 

Lewiston 

Clapperton, Gilbert, 

Lewiston 

Rand, George H., 

Livermore Falls 

Corrao, Frank P., 

Lewiston 

Randall, Ray N., 

Lewiston 

Cox, William, 

Lewiston 

Renwick, Ward J., 

Auburn 

Desaulniers, George E. D., 

Lewiston 

Rowe, G. H., 

Livermore Falls 

Dionne, Maurice, 

Brunswick 

Roy, Leopold 0., 

Lewiston 

Fahey, William J., 

Lewiston 

Russell, Blinn W., 

Lewiston 

Garcelon, Harold Webh, 

Auburn 

Russell, Daniel F. D., 

Leeds 

Gauvreau, Horace L., 

Lewiston 

Shnsoucy, J. A., 

Lewiston 

Gerrish, Lester P., 

Lisbon Falls 

Schneider, G. A., 

Lewiston 

Giguere, Eustache N., 

Lewiston 

Sprince, Henry, 

Lewiston 

Goldman, Morris E., 

Lewiston 

Steele, Charles W., 

Auburn 

Goodwin, Ralph A., 

Auburn 

Sweatt, Linwood, 

Strong 

Gottlieb, Julius, 

Lewiston 

Thomas, C. C., 

Lewiston 

Grant, Alton, Jr., 

Auburn 

Tousignant, Camille, 

Lewiston 

Greene, Merrill S. F., 

Lewiston 

Twaddle, G. W., 

Auburn 

Gross, L. C., 

Lewiston 

Viles, Wallace E„ 

Turner 

Hanscom, Oscar E., 

Greene 

Wakefield, Frederick S., 

Lewiston 

Harkins, Michael J., 

Lewiston 

Webber, Wallace E., 

Lewiston 

Haskell, William L., 

Lewiston 

Webber, Wallace P., 

Lewiston 

Hiebert, Joelle C., 

Lewiston 

Williams, James A., 

Mechanic Falls 

Higgins, Everett C., 

Lewiston 

Williams, R. E., 

New Gloucester 

Hutchins, G. H., 

Auburn 

Wiseman, Robert J., 

Lewiston 

James, Chakmakis, 

Lewiston 




Volume Thirty , No. 5 


Roster 


113 


AROOSTOOK COUNTY 


President 

Vice-President 

Secretary-Treasurer 


OFFICERS 
Oscar Norell, 
W. V. Kirk, 

A. T. Whitney, 

MEMBERS 


Caribou 
Eagle Lake 
Houlton 


Albert, Joseph L., 

St. Francis 

Hammond, H. H., 

Van Buren 

Bennett, Freeman E., 

Presque Isle 

Harvey, Thomas G., 

Mars Hill 

Berrie, L. H., 

Houlton 

Huggard, Leslie H., 

Limestone 

Blossom, Frank 0., 

Caribou 

Jackson, Frank H., 

Houlton 

Boone, Storer W., 

Presque Isle 

Kallock, H. F„ 

Fort Fairfield 

Brewer, Wilfred, 

Presque Isle 

Kimball, Herrick C., 

Fort Fairfield 

Burr, Charles G., 

Houlton 

Kirk, William V., 

Eagle Lake 

Carter, Loren F., 

Presque Isle 

Labbe, Onil B„ 

Presque Isle 

Chamberlain, William G., 

Fort Fairfield 

MacDougal, William A., 

Westfield 

Coleman, Francis, 

Eagle Lake 

Mitchell, Frederick W., 

Houlton 

Curtis, Alton K., 

Danforth 

Norell, Oscar, 

Caribou 

Damon, Albert H., 

Limestone 

Potter, John G., 

Houlton 

Dickison, Thomas S., 

Houlton 

Savage, Richard L., 

Fort Kent 

Doble, Eugene H., 

Presque Isle 

Sawyer, R. L., 

Fort Fairfield 

Dobson, H. L., 

Presque Isle 

Sincock, Wiley E., 

Caribou 

Donahue, Gerald H., 

Presque Isle 

Small, Harold E., 

Fort Fairfield 

Donovan, Joseph A., 

Houlton 

Somerville, Wallace B., 

Mars Hill 

Ebbett, George, 

Houlton 

Swett, Clyde I., 

Island Falls 

Ebbett, Penry L. B., 

Houlton 

Touissant, Leonid, 

Fort Kent 

Faucher, Francois J., 

Grand Isle 

Ward, Parker M., 

Houlton 

Gibson, William B., 

Houlton 

Whitney, Arthur T., 

Houlton 

Graves, Richard A., 
Gregory, Frederick L., 
Griffiths, Eugene B., 
Grow, Wiliam, 
Hagerthy, Albert B., 

Presque Isle 
Caribou 
Presque Isle 
Presque Isle 
Ashland 

Honorary Members 
Upham, George C., 

Upton, George W., 

White, William W„ 

Biddeford 

Sherman 

Houlton 



CUMBERLAND COUNTY 



OFFICERS 


President 

George A. 

Tibbetts, Portland 


Vice-President 

E. H. Drake, Portland 


Secretary-Treasurer Harold V. 

Bickmore, Portland 



MEMBERS 


Allen, John H., 

Portland 

Beach, Sylvester J., 

Portland 

Anderson, William D., 

Portland 

Beck, Henry W., 

Gray 

Asali, Louis A., 

Portland 

Bickmore, Harold V., 

Portland 

Austin, Lewis K., 

Portland 

Bishoffberger, John M., 

Naples 

Babalian, Leon, 

Portland 

Bishop, Lloyd W., 

Portland 

Barker, Nat B. T., 

Yarmouth 

Blaisdell, Elton R., 

Portland 


114 

The Journal of the 

Maine Medical Association 


Blake, James P., 

Harrison 

Hamilton, Virginia C., 

New York City 

Bradford, William H., 

Portland 

Haney, Ormel E., 

Portland 

Bramhall, Theodore C., 

Portland 

Hanlon, Francis W., 

Portland 

Brock, Henry H., 

Portland 

Hanson, Henry W., Jr., 

Cumberland Center 

Brown, Luther A., 

Portland 

Haskell, Alfred W., 

Portland 

Brown, Stephen S., 

Portland 

Hatch, Lucinda B., 

Portland 

Burrage, Thomas J., 

Portland 

Hawkes, Richard S., 

Portland 

Carmichael, Prank E., 

Portland 

Hay, Walter F. W„ 

Portland 

Casey, William L., 

Portland 

Heifetz, Ralph, 

Portland 

Center, Ervin A., 

Steep Falls 

Hills, Louis L., 

Westbrook 

Clancey, Daniel J., 

Portland 

Hogan, Chester, 

Portland 

Clark, Ralph H„ 

Hiram 

Holt, Eugene E., Jr., 

Portland 

Clarke, Chester L., 

Portland 

Holt, William, 

Portland 

Clough, Dexter J., 

Portland 

Howard, Harvey, 

Freeport 

Corson, Carl C., 

Portland 

Hunt, Charles H., 

Portland 

Cragin, Charles L., 

Portland 

Huntress, Roderick L., 

Portland 

Cummings, George 0., 

Portland 

Hynes, Edward A., 

So. Portland 

Curtis, Harry L., 

Portland 

Jamieson, James G. S., 

Portland 

Daniels, Donald H., 

Portland 

Johnson, Henry P., 

Portland 

Davis, Harry E., 

Portland 

Johnson, Oscar R., 

Portland 

Derry, Louis A., 

Portland 

Kupelian, Nessib S., 

West Pownal 

Dooley, Francis M., 

Portland 

Lamb, Frank W., 

Portland 

Dore, Kenneth E., 

Fryeburg 

Lamb, Henry W., 

Portland 

Dorsey, Frank D., 

Portland 

Lappin, John J., 

Portland 

Douphinett, Otis J., 

Portland 

Leighton, Adam P., 

Portland 

Drake, Eugene H., 

Portland 

Leighton, Wilbur F., 

Portland 

Drummond, Joseph B., 

Portland 

Little, Albion H., 

Portland 

Dunham, Carl E., 

Portland 

Lombard, Reginald T., 

South Portland 

Dyer, Henry L., 

Berlin, N. H. 

Lothrop, Eaton S., 

Portland 

Emery, Harry S., 

Portland 

Love, Robert B., 

Gorham 

Fagone, Francis A., 

Portland 

Macdonald, H. Eugene, 

Portland 

Ferguson, Franklin A., 

Portland 

Martin, Thomas, 

Portland 

Fickett, Jerome P., 

Naples 

Marston, Paul C., 

Kezar Falls 

Files, Ernest W., 

Portland 

McAdams, William R., 

Portland 

Fisher, Stanwood E., 

Portland 

McCrum, Philip H., 

Portland 

Fogg, C. Eugene, 

Portland 

McLean, E. Allan, 

Portland 

Foster, A. D., 

Portland 

Melnick, Jacob, 

Portland 

Foster, Benjamin B., 

Portland 

Miller, Thor, 

Westbrook 

Foster, Thomas A., 

Portland 

Milliken, Herbert E., 

Surry 

Geer, George I., 

Portland 

Milliken, John, 

Portland 

Gehring, Edwin W., 

Portland 

Mitchell, Alfred, Jr., 

Portland 

Getchell, Ralph A., 

Portland 

Monroe, B. S., 

Berlin, N. H. 

Goldman, Harold I„ 

Freeport 

Moore, Roland B., 

Portland 

Gordon, Charles H., 

Portland 

Morrison, Alvin A., 

Portland 

Gould, Arthur L., 

Freeport 

Moulton, Albert W., 

Portland 

Greco, Edward A., 

Portland 

Needelman, William R., 

Portland 

Hall, Earl S„ 

Portland 

Nichols, Estes, 

Portland 

Hamblen, Howard, 

South Windham 

O’Donnell, Eugene E., 

Portland 

Hamel, John R„ 

Portland 

Oram, Julius C., 

South Portland 


Volume Thirty, No. 5 


Roster 

115 

O’Sullivan, Timothy J., 

Portland 

Thompson, Philip P., 

Portland 

Ottum, Alvin E., 

Portland 

Tibbetts, George A., 

Portland 

Peaslee, C. Capen, Jr., 

Portland 

Tobie, Walter E., 

Portland 

Pepper, John L., 

South Portland 

Tougas, Raymond, 

Brunswick 

Peters, Clinton N., 

Portland 

Tymms, Wm. R., 

Whittier, Calif. 

Phillips, Robert T., 

Portland 

Upham, Roscoe C., 

Biddeford 

Pingree, Harold A., 

Portland 

Walker, Maribel Holt, 

Cape Cottage 

Pletts, Robert C., 

Brunswick 

Ward, John V., 

Portland 

Pudor, Gustav A., 

Portland 

Warren, Mortimer, 

Portland 

Richardson, Clyde E., 

Brunswick 

Webb, Harold, 

Brunswick 

Ridlon, Magnus G., 

Kezar Falls 

Webber, Isaac M., 

Portland 

Robinson, Carl M., 

Portland 

Webber, Millard E., 

Portland 

Robinson, Edward F., 

Portland 

Webster, Fred P., 

Portland 

Rowe, Daniel M., 

Portland 

Weeks, DeForest, 

Portland 

Ruhlin, Carl W., 

Iowa City, Iowa 

Welch, Francis J., 

Portland 

Sapiro, Howard, 

West Scarboro 

Wellington, J. Foster, 

Portland 

Sawyer, Samuel G., 

Cornish 

Wescott, Clement P., 

Portland 

Schwartz, Carol, 

Portland 

Wheet, Fred E., 

Westbrook 

Scolten, Adrian, 

New York City 

Whitney, Harlan R., 

Portland 

Shanahan, William H., 

Portland 

Whittier, Alice S., 

Portland 

Smith, Frank A., 

Cumberland Mills 

Wight, Donald G., 

Westbrook 

Smith, Owen, 

Portland 

Wilson, Clement S., 

Brunswick 

Spencer, Jack, 

Portland 

Woodman, George M., 

Westbrook 

Stetson, Elbridge G. A., 

Brunswick 

Zolov, Benjamin, 

Portland 

Stevens, Theodore M., 

Portland 

Honorary 

Members 

Stuart, Albert F., 

Portland 

Abbott, Edward S., 

Bridgton 

Swift, Henry M., 

Portland 

Bates, George F., 

Yarmouth 

Sylvester, Charles B., 

Portland 

Dunn, Bertrand F., 

Portland 

Tahachnick, Henry M., 

Portland 

Marshall, Bertrand F., 

Westbrook 

Tetreau, Thomas, 

Portland 

Patterson, H. J., 

Portland 

Thaxter, Langdon T., 

Portland 




FRANKLIN - COUNTY 

OFFICERS 


President 

Maynard 

Colley, 

Wilton 


Vice-President 

Lorrimer 

M. Schmidt, 

Strong 


Secretary-Treasurer James Reed, Farmington 



MEMBERS 



Arms, Burdett L., 

Farmington 

Pratt, George L., 


Farmington 

Bell, Charles W., 

Farmington 

Reed, James, 


Farmington 

Bowie, George, 

Rangeley 

Schmidt, Lorrimer M., 


Strong 

Brinkman, Harry, 

Wilton 

Springer, Frank, 


Farmington 

Colley, Maynard, 

Wilton 

Thompson, Cecil F., 


Phillips 

Croteau, Thomas, 

Chisholm 

Weymouth, Currier C., 


Farmington 

Currier, Everett B., 

Phillips 

White, Verdeil 0., 


East Dixfield 

Dunlap, Clarence, 

King field 

Honorary Members 


Floyd, Albion E., 

New Sharon 

Coburn, George H., 


Brookline, Pa. 

Moulton, John H., 

Rangeley 

Nichols, John W., 


Farmington 


II 6 


The Journal of the Maine Medical Association 


HANCOCK COUNTY 



OFFICERS 


President 

G. 

A. 

Neal, Southwest Harbor 


Vice-President R. 

B. 

Coffin, Southwest Harbor 


Secretary-Treasurer M. 

A. 

Torrey, Ellsworth 



MEMBERS 


Babcock, Harold S., 

Castine 


Neal, George A., Southwest Harbor 

Bliss, Raymond V. N., 

Bluehill 


Noyes, Benjamin L., 

Stonington 

Clark, Raymond W., 

Ellsworth 


Parcher, Arthur H., 

Ellsworth 

Coffin, Raymond B„ 

Southwest Harboi 


Parcher, George, 

Ellsworth 

Coffin, Silas Allen, 

Bar Harbor 


Shurtleff, George F., 

Steuben 

Crowe, James Hartley, 

Ellsworth 


Sumner, Charles, 

Sullivan 

Gray, Philip L„ 

Harborside 


Thegen, Edward, 

Penobscot 

Grindle, J. Lowell, 

Northeast Harbor 


Torrey, Marcus Allen, 

Ellsworth 

Holt, Hiram A., 

Winter Harbor 


Wakefield, Ralph W., 

Bar Harbor 

Knowlton, Charles C., 

Ellsworth 


Weymouth, Raymond E., 

Bar Harbor 

Morrison, Charles C., Jr., 

Bar Harbor 


Honorary Member 


Morrison, Elmer J., 

Bar Harbor 


Phillips, Joseph D., Southwest Harbor 


KENNEBEC COUNTY 


OFFICERS 

President Leon D. Herring, Winthrop 

Vice-President Blynn 0. Goodrich, Waterville 

Secretary-Treasurer Frederick R. Carter, Augusta 

MEMBERS 

Alexander, George W., Gardiner Cole, Fred M., 

Gardiner 

Allen, A. B„ 

Piermont, N. Y. 

Cook, Aaron, 

Waterville 

Bauman, Clair S., 

Waterville 

Coombs, George A., 

Augusta 

Bisson, Napoleon, 

Waterville 

Cromwell, Charles D., 

Fairfield 

Bourassa, Harvey J., 

Waterville 

Cyr, Gerald A., 

Waterville 

Breard, Joseph A., 

Waterville 

DeVeaux, Orwel F., 

Westbrook 

Bull, Frank B., 

Gardiner 

Fay, Thomas F., 

Augusta 

Bunker, Luther G., 

Waterville 

Freeman, Fred H., 

Pittsfield 

Campbell, George R., 

Augusta 

Gingras, Adolphe J., 

Augusta 

Carter, Frederick R., 

Augusta 

Goodrich, Blynn 0., 

Waterville 

Cates, Samuel C., 

East Vassalboro 

Gousse, W. L„ 

Fairfield 

Clason, Silas 0., 

Gardiner 

Guite, Leander A., 

Waterville 

Cobb, William O., 

Gardiner 

Hardy, Theodore E., Jr., 

Waterville 


Volume Thirty, No. 5 

Roster 


117 

Harlow, E. W., 

Waterville 

Newcomb, Charles H., 

Clinton 

Hendee, Walter W., 

North Vassalboro 

Nutting, James D., Jr., 

Hallowell 

Herring, Leon D., 

Winthrop 

O’Connor, W. J., 

Augusta 

Hill, Frederick T., 

Waterville 

Odiorne, Joseph E., 

Cooper’s Mills 

Hill, Howard F., 

Waterville 

Parizo, Harry L., 

Waterville 

Hurd, Allan C., 

Gardiner 

Piper, John 0., 

Waterville 

Hurd, B. P„ 

Waterville 

Pitman, Mason W. H., Riverdale on Hudson, N.Y. 

Irgins, Edwin R., 

Waterville 

Pomerleau, Ovid F., 

Waterville 

Jackson, Elmer H., 

Augusta 

Priest, Maurice A., 

Augusta 

Kagan, Samuel H., 

Augusta 

Reynolds, Ralph L., 

Waterville 

Kobes, Herbert R., 

Augusta 

Risley, Edward H., 

Waterville 

Lathbury, Vincent T., 

Augusta 

Shaw, Arthur A., 

Fairfield 

Levine, Harry, Jefferson Barracks, Mo. 

Shelton, M. Tieche, 

Augusta 

Libby, Ara B., 

Gardiner 

Small, Morton M., 

Waterville 

Lubell, M. F., 

Waterville 

Stubbs, Richard H., 

Augusta 

Mann, L. A., 

Augusta 

Totman, Virgil C., 

Oakland 

Marquardt, Matthias, 

Augusta 

Tower, Elmer M., 

Waterville 

McCoy, Thomas C., 

Waterville 

Towne, Charles E., 

Waterville 

McKay, Roland L., 

Augusta 

Towne, John G., 

Waterville 

McLaughlin, Clarence R., 

Gardiner 

Trask, B. W„ 

Augusta 

McLaughlin, Ivan E„ 

Gardiner 

Turner, Oliver W., 

Augusta 

McQuillan, Arthur H., 

Waterville 

Tyson, Forrest C., 

Augusta 

McWethy, Wilson H., 

Augusta 

Wheeler, Fred E., 

Waterville 

Merrill, Percy S., 

Waterville 

Wheeler, J. E., 

Togus 

Metzgar, John, 

Augusta 

Williams, Edmund P., 

Oakland 

Mitchell, R. L., 

Waterville 

Williams, F. T., 

Augusta 

Moore, Arnold W., 

Mt. Vernon 

Young, William J., 

Yonkers, N. Y. 

Moorehead, Matthew T., 

Togus 



Morrell, Arch H., 

Augusta 

Honorary 

Member 

Murphy, Norman B., 

Augusta 

Hill, J. Frederick, 

Waterville 


KNOX COUNTY 


OFFICERS 


President 

Vice-President 

Secretary-Treasurer 


Howard Apollonio, 
Charles B. Popplestone, 
A. J. FULLER, 

MEMBERS 


Camden 

Rockland 

Pemaquid 


Adams, Frederick B., 
Apollonio, Howard L., 
Belknap, Robert W., 
Bousfield, Cyril E., 
Brown, F. F., 
Campbell, F. G., 
Carswell, James, 


Rockland 
Camden 
Damariscotta 
North Haven 
Rockland 
Warren 
Camden 


Curtis, John B., 
Ellingwood, William A., 
Fogg, Neil A., 

Foss, Alvin W., 

Frohock, H. W., 

Fuller, Abbott J., 

Green, Archibald F., 


Brownville Junction 
Rockland 
Rockland 
Rockland 
Rockland 
Pemaquid 
Camden 


118 


The Journal of the Maine Medical Association 


Hall, Walter D., 
Hutchins, James G., 
Jameson, C. Harold, 
Keller, Benjamin H., 
Laughlin, J. W., 
Leach, Charles H., 
Leijonborg, Frans, 
Lenfest, S. R., 

North, Charles D., 
Polisner, Saul, 


Rockland 
Camden 
Rockland 
Thomaston 
Newcastle 
Tenant’s Harbor 
Liberty 
Waldoboro 
Rockland 
Camden 


Popplestone, Charles B., 
Proctor, Thomas E., 
Soule, Gilmore W., 
Tounge, Harry, Jr., 
Tweedie, Hedley V., 
Weisman, Herman J., 

Honorary 

Coombs, George H., 

Hart, Willis F„ 


Rockland 
Boothbay Harbor 
Rockland 
Camden 
Rockland 
Rockland 

Members 

Augusta 

Camden 


OXFORD COUXTY 


President 

Vice-President 

Secretary-Treasurer 


OFFICERS 

Dexter E. Elsemore, 
William T. Rowe, 

J. S. Sturtevant, 

MEMBERS 


Dixfield 
Rum ford 
Dixfield 


Adams, Lester, 

Hebron 

McCarty, Eugene M., 

Rumford 

Atwood, Harold F., 

Buckfield 

Monkhouse, William M., 

No. Fryeburg 

Aucoin, Pierre B., 

Rumford 

Moody, Harry A., 

Rumford 

Bean, Johnson L., 

Norway 

Nelson, Chelsey W., 

Norway 

Burr, Thomas S., 

Rumford 

Noyes, PI. L., 

Rumford 

Corlis, Leland M., 

West Paris 

Pearson, Henry, 

Brownfield 

Courville, Albert L., 

Rumford 

Rowe, William T., 

Rumford 

Daniels, S. David, 

Lewiston 

Royal, Albert P., 

Rumford 

Defoe, Garfield G., 

Dixfield 

Smalley, Fred Lyman, 

Andover 

Dixon, Walter G., 

Norway 

Stanwood, Harold W., 

Rumford 

Eastman, Charles W., 

Canton 

Stewart, Delbert M., 

South Paris 

Elsemore, Dexter E., 

Dixfield 

Tibbetts, Raymond R., 

Bethel 

Gould, George I., 

Andover 

Villa, Joseph A., 

South Paris 

Greene, John A., 

Rumford 

Wilson, Harry MacKay, 

Bethel 

Howard, Henry M., 

Rumford 



Hubbard, Roswell E., 

Waterford 

Honorary Members 


Leslie, Frank E., 

Mendota, Wis. 

Binford, Horace J., 

Mexico 

Logan, G. E. C., 

Lovell 

Bisbee, Charles M., 

Rumford 

MacDougall, Janies A., 

Rumford 

Sturtevant, James S., 

Dixfield 


Volume Thirty, No. 5 


Roster 


II 9 


PENOBSCOT COUNTY 

OFFICERS 

President F. D. Weymouth, Brewer 

Vice-President Allan Woodcock, Bangor 

Secretary-Treasurer Forrest B. Ames, Bangor 

MEMBERS 


Adams, A. C., 

Orono 

Memmelaar, Joseph, 

Brewer 

Ames, Forrest B., 

Bangor 

Merrill, Earl S., 

Bangor 

Bayard, Clayton H., 

Orono 

Moise, Theodore S., 

Bangor 

Blaisdell, Carl E., 

Bangor 

Moulton, Manning C., 

Bangor 

Bryant, Bertram L., 

Bangor 

Pearson, John J., 

Old Town 

Burgess, Charles H., 

Bangor 

Peters, William C., 

Bangor 

Butler, Harry, 

Bangor 

Pressey, Harold E., 

Bangor 

Clement, James D., 

Bangor 

Purinton, Watson S., 

Bangor 

Cox, James F., 

Bangor 

Purinton, William A., 

Bangor 

Craig. D. Allan, 

Bangor 

Redman, Samuel J., 

Dexter 

Cutler, Lawrence, 

Bangor 

Ridlon, Magnus F., 

Bangor 

Dunham, Rand A., 

East Millinocket 

Robinson, Harrison L., 

Bangor 

Emerson, Oscar R., 

Newport 

Sanger, Eugene B., 

Bangor 

Emerson, W. M., 

Bangor 

Schriver, A. H., 

Bangor 

Emery, Clarence, Jr., 

Bangor 

Schriver, Allen E., 

Brewer 

Feeley, J. Robert, 

Bangor 

Scribner, Herbert C., 

Bangor 

Fellows, Albert W., 

Bangor 

Sherrard, Frederick D., 

Winn 

Goodrich, Edward P., 

Winterport 

Silsby, Samuel S., 

Bangor 

Gregory, Irving F., 

Bangor 

Skinner, Peter S., 

Bangor 

Gumprecht, Walter R 

Bangor 

Skofield, Ezra B., 

Corinth 

Hall, Walter C., 

Orono 

Small, Amos E., 

Bangor 

Hammond, Walter J., 

Bangor 

Smith, Leroy H., 

Winterport 

Hedin, Carl J., 

Bangor 

Strout, Arthur C., 

Dexter 

Herlihy, Edward L., 

Bangor 

Taylor, Cornelius J., 

Bangor 

Higgins, George I., 

Newport 

Taylor, Herbert L., 

Dexter 

Hill, Allison K., 

Bangor 

Theriault, Louis L., 

Old Town 

Hinman, Havilah E„ 

Orono 

Thomas, Calvin M., 

Brewer 

Horton, George H., 

Hermon 

Thompson, Herbert E., 

Bangor 

Hoyt, John M., 

Bangor 

Thompson, John B., 

Bangor 

Hunt, Barbara, 

Bangor 

Todd, Albert C„ 

So. Brewer 

Hunt, Harrison J., 

Bangor 

Trickey, Winfield B., 

Pittsfield 

Knowlton, Henry C., 

Bangor 

Varney, John R., 

Old Town 

Lethiecq, Joseph A., 

Brewer 

Vickers, Martyn A., 

Bangor 

Lezberg, Joseph, 

Bangor 

Way, George F., Jr., 

Lincoln 

Libby, Harold E„ 

Lincoln 

Weatherbee, George B., 

Hampden 

Loud, Norman W., 

Bangor 

Webber, Merlon A., 

Pittsfield 

Madden, Martin C., 

Old Town 

Weymouth, Frank D., 

Brewer 

Mansfield, Blanche M., 

Bangor 

Whalen, Henry E., 

Dexter 

Mason, Luther S., 

Bangor 

Whitworth, John E., 

Bangor 

McKay, Hugh G., 

Old Town 

Witte, Max E., Jr., 

Bangor 

McNamara, Wesley C., 

Lincoln 

Woodcock, Allen, 

Bangor 

McNeil, Harry D., 

Bangor 

Wright, Laforest J., 

Bangor 

McQuoid, R. M., 

Bangor 

Young, Ernest T., 

Millinocket 


120 


The Journal of Maine Medical Association 


PISCATAQUIS COUNTY 


President 
Vice-President 
Secre tnry- Treasurer 


OFFICERS 

Harvey C. Bundy, 

W. R. L. Hathaway, 
N. H. Nickerson, 


Milo 

Milo 

Greenville 


Brown, M. O., 

Bundy, Harvey C., 
Carde, Albert M., 
Crosby, Nathaniel H., 
Dore, Guy E., 
Hathaway, William R., 
MacDougal, Wilbur E., 
Marsh, Burton S., 
Marsh, Ralph H., 


MEMBERS 


Dover-Foxcroft 

Milo 

Milo 

Milo 

Guilford 

Milo 

Dover-Foxcroft 
Greenville Jet. 

Guilford 


Nickerson, Norman H., 
Pritham, Fred J., 
Stanhope, Charles N., 
Stuart, Ralph C., 
Thomas, Ruth B., 
Thomas, William B. S., 

Honorary 

Merrill, E. D„ 


Greenville 
Greenville Jet. 
Dover-Foxcroft 
Sangerville 
Dover-Foxcroft 
Dover-Foxcroft 

Memrer 

Dover-Foxcroft 


SAGADAHOC COUNTY 

OFFICERS 

President E. F. Pratt, 

Vice-President H. D. Grant, 

Secretary-Treasurer F. A. Winchenbacii, 

MEMBERS 


Bailey, Bernard A., 

Wiscasset 

Owen, Albert S., 

Bath 

Day, DeForest S., 

Wiscasset 

Pratt, Edwin F., 

Richmond 

Fuller, E. M., Jr., 

Bath 

Smith, Jacob, 

Bath 

Fuller, Edwin M., 

Bath 

Smith, Joseph I., 

Bath 

Grant, Hugh, 

Bath 

Snipe, Langdon T., 

Bath 

Gregory, George A., 

Boothbay Harbor 

Stott, Ardenne A., 

Bath 

Joss, Merrill E., 

Richmond 

Williams, Adelbert F., 

Augusta 

Kershner, Warren E., 

Bath 

Winchenbach, Francis A., 

Bath 

Morin, Harry F., 

Bath 




Richmond 

Bath 

Bath 


Volume Thirty ; No. 5 


Roster 


121 


SOMERSET COUNTY 


President 

Vice-President 

Secretary-Treasurer 


Ball, Franklin P., 

Bingham 

Briggs, Paul R., 

Hartland 

Brown, Ray C., 

Skowhegan 

Caza, 0. J., 

Skowhegan 

Earle, Fred E., 

Weeks’ Mills 

Gilbert, Percy E., 

Madison 

Humphreys, Ernest D., 

Jackman Sta. 

Hutchins, Eugene L., 

North New Portland 

Laney, Richard P., 

Norridgewock 

Lord, Maurice E., 

Skowhegan 

Marston, Henry E., 

North Anson 

Milliken, Walter S., 

Madison 

Norris, Lester F., 

Madison 


Fairfield 

Madison 

Skowhegan 


Reed, Howard L„ 

Madison 

Smith, Harry W., 

Norridgewock 

Stinchfield, Allan J., 

Skowhegan 

Stinchfield, Walter S., 

Skowhegan 

Sullivan, George E., 

Bingham 

Tozier, Frank L., 

Fairfield 

Waters, Wilson H., 

Fairfield 

Young, George E., 

Skowhegan 

Honorary Members 

Ellingwood, Louis N., 

Athens 

Moulton, Charles A., 

Hartland 

Robinson, Frank J., 

Fairfield 


OFFICERS 
W. H. Walters, 
P. E. Gilbert, 
M. E. Lord, 

MEMBERS 


President 

WALDO COUNTY 

OFFICERS 

Eugene L. Stevens, 

Belfast 

Vice-President 

George F. Miller, 

Belfast 

Secretary-Treasurer 

Raymond L. Torrey, 

Searsport 


MEMBERS 



Larrabee, Burton E., 
Miller, George F., 
Nesbitt, Lester R., 
Pattee, Sumner C., 
Small, Foster C., 
Stevens, Carl H., 


Belfast 

Belfast 

Bucksport 

Belfast 

Belfast 

Belfast 


Stevens, Eugene L., 

Tapley, Eugene D., 

Torrey, Raymond L., 

Honorary Member 
Kilgore, Albert E., 


Belfast 

Belfast 

Searsport 


Brooks 


122 


The Journal of the Maine Medical Association 


WASHINGTON COUNTY 


President 

Vice-President 

Secretary-Treasurer 


OFFICERS 
John T. Metcalf, 
P. J. Mundte, 
Oscar F. Larson, 


Lubec 

Calais 

Machias 


Armstrong, C. M., 
Bates, James C., 
Bennett, DaCosta F., 
Best, Herbert H., 
Bunker, Willard H., 
Burritt, Guy L., 
Cobb, N. E„ 

Crane, James W., 
Dyas, A. D„ 

Gilbert, Walter J., 
Grubin, H., 

Hanson, John F., 


MEMBERS 


Robbinston 
Calais 
Lubec 
Pembroke 
Calais 
Harrington 
Calais 
Woodland 
St. Stephen, N. B. 

Calais 

Lubec 

Machias 


Larson, Oscar F., 
Metcalf, John, 
Miner, Walter N., 
Mundie, Perley J., 
Murphy, John L., 
Webber, Samuel R., 
White, Ernest A., 


Machias 
Lubec 
Calais 
Calais 
Eastport 
Calais 
Columbia Falls 


Honorary Members 

Bennett, Eben H., Lubec 

Hunter, Sarah L., Machias 

McDonald, John A., East Machias 


YORK COUNTY 


President 

Vice-President 

Secretary-Treasurer 


OFFICERS 
Dana B. Mayo, 
W. T. Roussin, 
C. W. Kingiiorn, 


South Eliot 
Biddeford 
Kittery 


MEMBERS 


Baker, William H., 

West Buxton 

Cobb, Stephen A., 

Sanford 

Cook, Edward C., 

York Village 

Cook, Edward M., 

York Harbor 

Cuneo, Kenneth J., 

Kennebunk 

Davis, Ansel S., 

Springvale 

Dennett, Carl G., 

Saco 

Dolloff, David E., 

Biddeford 

Durgin, Henry I., 

South Eliot 

Elliott, William T., 

Berwick 

Hawkes, Edgar S., 

Kennebunk 

Head, Owen B., 

Sanford 

Hill, Paul S., 

Saco 

Hill, Paul S„ Jr., 

Saco 

Holland, Edward W., 

Springvale 

Ilsley, Harris P., 

Limington 

Jones, A. L., 

Old Orchard 

Kelley, William H., 

Sanford 

Kendall, Clarence F., 

Washington, D. C. 

Kinghorn, Charles W., 

Kittery 

Lamoreux, Arthur C., 

Sanford 

LaRochelle, Joseph R., 

Biddeford 

Lightle, William E., 

North Berwick 

Lord, Frederick C., 

Saco 

Love, George R., 

Saco 


MacDonald, James H., 

Kennebunk 

Mayo, Dana B., 

South Eliot 

Morse, W. L., 

Springvale 

O’Gara, Emmet F., 

South Berwick 

Owen, Herbert A., 

Bar Mills 

Perrault, Oscar, 

Biddeford 

Prescott, Harry L., 

Kennebunkport 

Richards, Carl E., 

Alfred 

Ross, Frank A., 

South Berwick 

Ross, H. D., 

Sanford 

Roussin, W. T., 

Biddeford 

Shapleigh, Edward E., 

Kittery 

Small, Fitz E., 

Biddeford 

Smith, Gerald, 

Ogunquit 

Smith, William W., 

Ogunquit 

Stickney, Laura B., 

Saco 

Stimpson, Arthur J., 

Kennebunk 

Thompson, Clarence E., 

Saco 

Wiley, Arthur G., 

Bar Mills 

Winch, A. W., 

Sanford 

Xaphes, Chrysaphes J., 

Biddeford 


Honorary Members 
Gordon, Joseph W., 


Ogunquit 



The Journal 

of the 

Maine Medical Association 


Uolume Thirty Portland, Ulaine, June, 1939 No. 6 


The Legal Status of the Intern* 

By Fred Ellsworth Clow, M. D., F. A. C. P., 

Secretary of the Few Hampshire State Board of Registration in Medicine 

HSTTERH : A resident or indoor physician or surgeon ( Borland). 

Syn : House Officer: House Physician: or House Surgeon. 


In the last quarter century twenty-one 
states and Alaska have made the hospital 
service a requirement for licensure. Some 
medical schools withhold the degree until one 
year at least has been served. In 1938 the 
Council on Medical Education and Hospitals 
reported for the United States 7351 intern- 
ships in 729 approved hospitals and for Can- 
ada 18 approved hospitals. A change has been 
noted in the place of the intern in the educa- 
tional scheme. Whereas, in the past the ser- 
vice in the hospital was considered postgrad- 
uate training, and optional with the student, 
longer training as a resident is now required, 
and the intern is regarded more as an under- 
graduate, still pursuing his medical course, 
learning the art as well as the science of 
medicine. With increased responsibility has 
come the necessity for wider knowledge, more 
maturity of judgment and better poise. 

When the intern enters the hospital he 
learns, for the first time in his life that he is 
liable for his acts, not only as an individual 


member of society, but as a professional man. 
Besides once the medical student comes in 
intimate contact with patients he is amen- 
able to the statute governing the practice of 
medicine in his state. For the first time his 
every word and every act is scrutinized, often 
remembered, and frequently misunderstood 
by a person rendered hypercritical by illness. 
The intern can, by a thoughtless remark alone 
cause a malpractice suit for the physician re- 
ferring the patient. Observations concerning 
previous diagnosis and treatment are partic- 
ularly dangerous, because the patient rarely 
understands and never correctly describes 
any medical opinion or procedure. 

With improvement in the technic of diag- 
nosis and treatment, and the consequent 
increase in mechanical manipulations, the 
opportunities for costly mistakes are enor- 
mously increased. Thoughtful men in all de- 
partments of medicine are disturbed at the 
way in which litigation is increasing, the ease 
with which it can be started, the complicated, 


* Read before the Thirty-Fifth Annual Congress on Medical Education and Licensure, Chicago, Feb. 
14 , 1939 . 


124 


The Journal of the Maine Medical Association 


costly, and to physicians the cumbersome 
methods of the law. They are astounded at 
the ease with which the slightest slip in tech- 
nic is magnified when presented to a jury of 
laymen, and the difficulty of getting the truth 
to prevail. The hospital may protect its 
property and its employees ; the visiting staff 
can rely on the insurance company to assume 
liability. Apparently the intern, if attacked 
as an individual is without protection. One 
insurance company in Hew England, with 
long experience in this field, offers no way in 
which fhe intern may be covered. Another 
company specializing in liability insurance 
replies : “Our Hospital Policy covers the 

liability of a hospital on account of the negli- 
gent acts of interns, resident physicians, and 
medical students. It will not, however, cover 
fhe liability of resident physicians, interns or 
medical students themselves.” Insurance 
companies demand a certain competence, ex- 
perience, medical society membership and the 
good opinion of men of the same standing. 
House officers cannot yet meet these stand- 
ards. Besides, it appears that if a liability 
contract were devised the high cost would be 
a deterrent to many young men still under 
expense of education. Until the legal status 
of the intern is determined by precedents, or 
better by statute the hospital can scarcely af- 
ford to insure him. 

The hospital has a selfish interest in pro- 
tecting the intern from himself for its own 
salvation. One can but feel that too often the 
intern is given too much latitude in the con- 
duct of ward service. fSTo one believes today 
that an internship prepares any man to be- 
come a safe, conservative surgeon. And that 
often appears to be the aim of the student 
himself. Some of the dissatisfaction existing 
in unnecessary and harmful operative work 
done in private practice springs from the 
practice of permitting the house surgeon to 
do by himself operations for which he is not 
trained. 

Many hospitals with a small resident staff 
require much routine administrative duties 
and the assumption of altogether too much 
responsibility in the performance of techni- 
cal procedures. Hospital administrators com- 
plain that the intern is poorly prepared to do 
lii's job. 

As has been pointed out by more than one 


hospital executive the intern is entitled not 
only to the conventional precedent book of 
routine matters, but he should be introduced 
to his new duties by someone who will be a 
sympathetic adviser, who can interpret to the 
newcomer methods and customs of that hos- 
pital, in which otherwise he may grope and 
stumble during his whole appointment. 

He should be taught that hospitals are 
complicated organisms, serving in a most 
personal manner the public made up of all 
types of individuals, dealing with persons 
sensitized by illness, with relatives and 
friends even more demanding and more crit- 
ical. The opportunities for trouble in the hos- 
pital exist in every procedure, every minute 
of the day, and involving every employee and 
officer, and every physical feature of the 
plant. 

The intern is charged with the duty of 
carrying out the instructions of the attend- 
ing physician except in emergency. When an 
emergency arises it is incumbent on the in- 
tern to exercise his own judgment until 
report can be made to and instructions re- 
ceived from the attending physician. 

The intern may be charged with failure to 
obtain consent for an operation from a hus- 
band or the parent of a minor. Care must be 
used that state laws be observed. Permissions 
should be reviewed by the superintendent’s 
office. He is liable for malpractice in the case 
of a minor, to the majority of the patient and 
whatever the statute of limitations may be be- 
yond that; in one state to the age of twenty- 
three. 

In obtaining permission for necropsy the 
intern must get the signature of the right per- 
son, preference being given to the relative 
who assumes control of the body, bearing in 
mind that a minor cannot grant permission, 
though he is the sole survivor. One must be 
certain that the person granting permission 
clearly understands the nature of the necrop- 
sy, and that the scope is definitely estab- 
lished, as well as understood and followed by 
the pathologist. Where the coroner system 
prevails one must be careful in doing autop- 
sies on the orders of that officer. Limitations 
of his power exist and outraged relatives may 
cause difficulty. Every city has regulations 
as to what constitutes medico-legal or “Med- 
ical Examiner’s” cases, including abortions, 


Volume Thirty , No. 6 


The Legal Status of the Intern 


125 


prisoners, wounds and deaths from criminal 
violence. Failure to report such may be seri- 
ous for the hospital. 

The house officer is amenable to the law, 
and held for his acts in privileged communi- 
cations, in the same way as physicians in pri- 
vate practice. He is forbidden to communicate 
with patients for the purpose of engaging 
the services of attorneys ; he is forbidden 
to report deaths to, or recommend particular 
undertakers. He may be summoned to 
court with hospital records and compelled to 
testify to facts. Interns must respond to sub- 
poena, but hospitals may and sometimes do 
refuse to disclose the names of members of 
the house staff who have treated patients in- 
volved in lawsuits, because much time is lost 
in attending court. An intern at a charity 
hospital referred accident cases which he had 
solicited to two attorneys. Although he denied 
an agreement, he fully expected to be paid. 
He was advised to plead guilty to the charge 
and was sentenced to three months in the 
penitentiary. The intern is subject to the 
national and state income tax laws. The sup- 
erintendent of the hospital returns to the tax 
authority each year the list of employees hav- 
ing a minimum income, with board and liv- 
ing, if furnished, computed at approximately 
$500 per year. 

Many hospitals are getting a larger num- 
ber of personal injury, street accidents and 
compensation cases than ever before. Larger 
numbers of citizens come within the cate- 
gories covered by various types of protection. 
The intern will treat many more of these 
cases in a short service than the private 
physician. The hospital should, therefore, 
have a clearly defined routine for his guid- 
ance, since the payment of the hospital bill, 
and the patient's chances of financial recov- 
ery depend so much on prompt and proper 
reporting. 

The national Wagner Act, and the little 
Wagner Act of the states brings the place of 
the intern as an employee to the serious con- 
sideration of hospital authorities. Intern’s 
councils, formed for scientific purposes for 
the maintenance of standards, should not be 
the cells for labor agitation. 

It is unfortunate that social legislation 
compels the hospital to place the intern in 
the category of employees. “An employee is 


one whose duties consist in the rendition of 
prescribed services and not the accomplish- 
ment of specific objects, and whose services 
are continuous, not occasional or temporary." 

For compensation purposes the intern is 
covered by the law governing employees. In- 
terns and nurses in a hospital maintained by 
municipal or other political units are also 
within the compensation law coverage. In a 
case of voluntary insurance by a charitable 
trust an intern is also held to be an employee. 
An intern in the Cook County Hospital con- 
tracted epidemic meningitis and died. An 
award to his widow by the arbitrator was set 
aside by the industrial commission but it was 
affirmed by the circuit court and by the 
Supreme Court of Illinois. When the Social 
Security Act is extended to include hospitals 
the house officer will doubtless be included 
in its coverage. 

Ho general doctrine exists fixing the limits 
of responsibility of different types of hos- 
pitals and the different classes of persons 
attached to the hospitals. Court decisions 
vary from state to state. House officers, along 
with pathologists, roentgenologists, as well as 
private physicians and special duty nurses 
are classed as non-administrative employees. 
The general rule is that the hospital is not 
liable for their negligence. Administrative 
employees, all those attached to the superin- 
tendent's office, for instance, form the other 
group. Responsibility for their conduct may 
rest upon the hospital, a knotty problem 
which the courts have considered for years. 

Ever since 1816 when the theory of ab- 
solute immunity of the charitable institution 
resting on its “trust funds’’ was annunciated, 
down to the present time many court decisions 
have been handed down. Some states have 
accepted decisions of the Hew York State 
courts in large part. Confusion has resulted, 
largely because there has been no movement 
by those most interested to clarify matters by 
legislative enactment. 

“Instability of economic conditions, es- 
pecially within the last ten years, has greatly 
altered, and visibly changed the mental re- 
actions of the average individual within our 
community. Particularly in the larger popu- 
lation centers, the older, confidential and 
trusted relationship between the physician 
and his patient has given way to habits of 


12 6 


The Journal of the Maine Medical Association 


medical shopping. There has been an in- 
creasing tendency to seek legal redress 
through malpractice claims.” 

No uniform policy for limited licensure 
or exemption of interns from provisions of 
the law exist in the various state enactments. 
Thirty-six states practically ignore the medi- 
cal student and the intern. Sixteen states 
have statutory provision, most of them being 
exceptions to the application of the medical 
practice act. In a few states, the intern and/ 
or the medical student is affirmatively per- 
mitted to practice medicine in a hospital un- 
der the guidance of teachers. Apparently, 
Massachusetts alone, grants “limited regis- 
tration” for the definite period of his intern- 
ship, upon completion of three and one-half 
years of medical study in approved schools. 
Limitations are placed on the activities of 
such students, and the hospital and the other 
institutions to which they are attached under 
the direction of staff members. For the 
period of his limited registration the intern 
is permitted to sign birth and death certifi- 
cates. -- 1 

New Hampshire permits “resident physi- 
cians” to practice in any legally incorporated 
hospital. This is not wholly satisfactory since 
no report of appointment is required of the 
“resident” or the hospital. Supervision can- 
not be exercised by the board of registration. 
Physicians ineligible for registration may be- 
come, for an indefinite period, whole time 
members of the staff of such institutions as 
the state tuberculosis sanatorium, or the hos- 
pital for mental diseases, without compliance 
with the medical act. A lenient attitude is 
shown interns apparently by boards of regis- 
tration out of consideration for the financial 
position of these young men, many of whom 


do not intend to locate in the state. All of 
them are known to be under the supervision 
of mature staff members, who with the hos- 
pital are presumed to be responsible for the 
conduct, of house officers. 

But should the intern as an unlicensed 
physician be charged with malpractice he is 
indeed vulnerable, and his defense is handi- 
capped. The attorney for the plaintiff em- 
phasizes the illegality of his action. In 
addition to the charge of professional miscon- 
duct he is charged with crime. In some in- 
stances where the hospital has been freed of 
the charge of negligence the intern himself 
has been charged with the same offense. 

It is a fact that some hospitals are under- 
staffed and interns, some routine adminis- 
trative work being essential, may be lmrried 
or become careless, or because of fatigue make 
the fatal slip in technic or the thoughtless 
remark that leads to trouble. Sufficient over- 
sight by the staff and relief from some routine 
will prevent such errors. To the ward patient 
the intern is the patient’s doctor, coming 
closer, by far, to the man or woman than the 
chief visiting surgeon. We cannot forget 
that. 

It may be argued that the chances for mal- 
practice suits involving the intern are rare. 
But the slight yet perceptible increase in this 
sort of litigation, and the eagerness of at- 
torneys for business does not increase safety 
of the intern. Such cases, like many others 
taken on a contingent fee basis, possess a 
nuisance value at least. Some settlement, 
however small, must bo made, or one must 
face the alternative of expensive litigation. 
Attention should be directed to the evolution 
of some scheme for protection of the intern 
from attack. 


Tuberculosis and Appendicitis — Eight 
more cases of tuberculous appendicitis were 
added recently to the report of the 151 al- 
ready in the literature prior to May, 1937. 
The clinical course of the disease tends to 
chronicity, with recurrent attacks usually 
milder than the pyogenic types of appendi- 
citis. Earlier recognition and early operation 


are urged. Card, T. A., Cal. West. Med., 
1939, 50. 

Tuberculosis is Mass Murder — It would 
cost this country a hundred times less money 
to wipe out tuberculosis in one generation 
than to maintain this ghastly luxury for an 
indefinite period, according to Paul de Kruif. 


Volume Thirty, No. 6 


Poor Patients in Hospital Wards 


127 


Poor Patients in Hospital Wards* 

By Sister Ricard, St. Mary’s General Hospital, Lewiston, Maine 


Before replying to the very kind invita- 
tion of Doctor Hiebert, the distinguished 
President of the Maine Hospital Association, 
I confess I felt bound to hesitate about ac- 
cepting it from fear lest this might be in- 
consistent with the customs of our Religious 
Order. However, after reflection and con- 
sultation, I have thought I ought to accept 
in the hope of making, even to such a body 
as this, some modest suggestions on a subject 
close to my heart, one which may be said to 
explain the existence of my dear Commun- 
ity, the Sisters of Charity. I wish to speak 
to you of the need of making best possible 
provision for the invalid poor. 

Even if, in a hospital, it is our duty to 
show love and care of invalids of every sort, 
it seems to me we are bound to pay particular 
attention to the poor patients in our hospital 
wards. Poor patients, whoever they may be, 
are usually more or less distressed and ill at 
ease in an environment which is wholly 
strange to them and involves contact with 
those who are entire strangers. Moreover, 
those with sensitive natures find it hard to 
be surrounded by neighbors who differ from 
them in education and social position. Often 
too, the way in which they have heard people 
speak of hospital wards has been unfavor- 
able; they are filled with prejudices, which 
only the best of care, kindness, and personal 
devotion can dispel. It is, therefore, of great 
importance to inspire them with feelings of 
confidence and security from the moment of 
their arrival. First impressions largely de- 
termine the amount of good the hospital may 
do them. On the one hand, these may make 
the patient confident, hopeful, and ready to 
submit willingly to everything required, or, 
on the other, to make him restless and sus- 
picious, and so likely to show unfavorable 
physical reactions. 

It is a great mistake to let a poor patient 
suspect that he is only a “case” rather than 
a person, that as a “case” he may be possibly 
of more or less interest, but that as an indi- 


vidual, suffering perhaps more in spirit than 
in body, he is only to be ignored. Once in- 
stalled in the hospital ward, he will probably 
find more comfort and care than he could 
have anywhere else ; yet it is also highly im- 
portant that doctors and nurses show such 
an interest in the patient personally as to 
give him a conviction that they will do all in 
their power to ensure him best chances of 
recovery. 

Several years ago, a newspaper-writer pub- 
lished an article on “Beauty in the Hospi- 
tal”. With full appreciation of this work of 
his, I wish he might be inspired to write 
another on “Kindness and Personal Sym- 
pathy in the Hospital.” We are all in sym- 
pathy with this writer’s plea for Beauty in 
the surroundings of our patients. We wish 
to provide them not only with comforts, but 
also with luxuries. We know the value, as 
an aid to their convalescence, of having all 
their surroundings restful and attractive. 
Beauty is good, Ugliness an evil. Yet sur- 
roundings need not be ugly, even if they have 
to be very simple and very plain ; and there 
is one form of beauty, a necessity which 
ranks as one of the highest luxuries, at which 
all of us who have care of the sick must con- 
stantly aim. That is the necessity and luxury 
of cleanliness. Nothing conduces more to 
the welfare of our patients than that every- 
thing about them, their bodies, their beds, 
their wards, should be kept as nearly spotless 
as possible. There are few places where this 
is more difficult than, in a hospital ward. It 
can only be had at cost of constant watchful- 
ness and constant hard work ; but we can 
often pay prices in hard work for things 
which we could not secure by paying prices 
in money. One thing which we who have 
care of the sick can spare no pains to secure 
is that neatness and orderliness, which counts 
for so much in comfort, convalescence, and 
cures. This is one of the chief forms of 
beauty and luxury that we can give them. 
Especially do our poor patients need this. 


* Read before the 1938 Annual Meeting of the Maine Hospital Association held at Lakewood, August 
31, 1938. 


128 


The Journal of the Maine Medical Association 


Oftentimes we trv to establish for them 
«/ 

stricter standards of cleanliness than they 
have ever established for themselves ; often 
they find some of our requirements irksome ; 
but, in the long run, nothing counts for more 
in their physical welfare or is more appre- 
ciated. If they come from homes filled with 
dirt and disorder, or from no homes at all, 
all the more must we try to provide that 
cleanliness which is next to godliness in our 
hospital wards. Among the highest beauties 
of the hospital are clean bodies, clean beds 
and clean floors. 

But when all has been said of the desira- 
bleness of Beauty, there is a greater desira- 
bleness in Kindness and Sympathy, and this 
not least in regard to our poor patients. Far 
better than pictures of the great masters, 
then flowers and luxurious appointments ar- 
ranged with taste, will we find for promotion 
of the welfare of our patients the under- 
standing spirit of true charity. That is the 
ideal for us all to follow in obedience to a 
universal law affecting all creation from low- 
est to highest, that all lesser things must be 
so used as to secure the greatest good of all. 
“If I should distribute all my goods to feed 
the poor, and if I should deliver my body 
to be burned, and have not charity, it profit- 
eth me nothing.” 

Every sick person, as we all know, be- 
comes in some degree a child, a human being- 
in need of support, protection, and help, al- 
most unconsciously self-abandoned to the dis- 
interested love of some other person. In a 
word, he wishes and wills to be protected. 
He longs for compassion which his spirit 
hopes to find in the twofold power of others 
to understand and to soothe and soften him. 
The poor patient makes special claims on our 
sympathy. Removed from his ordinary sur- 
roundings and course of life, he is especially 
liable to be seized with melancholy. His per- 
sonal cares, worries and needs, probably in- 
creased by enforced inaction, become obses- 
sions. Many who have taken pride in their 
health, as others feel vanity over good for- 
tune, experience in times of weakness a sort 
of humiliation which irritates them. It is 
necessary for the nurses to grudge no time 
or trouble, for the doctor wisely to detect 
this sort of distress, that they may bring the 
necessary solace. Confronted by kindness, 


the greatest sufferer forgets pain, the most 
discouraged recovers hope, the worst grum- 
bler becomes fairly good-natured. Even the 
insensibility of a woodman may be van- 
quished. One incident among a thousand 
that might be cited, will illustrate what I 
am saying. 

To one of our hospitals, sometime during 
the past two years, came a man whose occu- 
pation was that of a trapper. He was suffer- 
ing terribly from pains in the stomach ap- 
parently caused by ulcers. An operation was 
performed with utmost care by one of the 
house-surgeons, only to disclose that the dis- 
ease was fatal. The nurses, although know- 
ing the case hopeless, showed every interest 
and care, despite the fact that to all their 
kindness the sick man only responded by 
bursts of anger, sometimes even by curses. 
The doctor, though ready to do all in his 
power, thought best to make his visits infre- 
quent to avoid the man’s tiresome and use- 
less complaints. The trapper noticed this, 
thought himself neglected and assailed one 
of the nurses : “I know that the doctor is 
ashamed of the bad job lie has made with 
me; that is the reason he keeps away.” The 
nurse tried to reassure him, and spoke tact- 
fully of the doctor’s regret he could not ef- 
fect a cure, a fact not before told the patient 
for fear of making him worse. The man was 
at last convinced that he had not been neg- 
lected, and that doctors and nurses were do- 
ing all in their power to secure his comfort. 
I’he nurse’s sympathetic words at last made 
their impression. There was a sudden 
change ; the man became more trustful ; he 
who at his arrival had shown himself such a 
rebel, became responsive and resigned, and 
so continued until the moment of death. The 
kindness and patience of doctor and nurses 
had helped him to gain a self-control which 
brought a sort of eternal serenity, which, we 
may hope, he still enjoys. 

Too many people have prejudices against 
the hospital, which, on all accounts, must be 
made to disappear. The hospital must prove 
its usefulness, its necessity, its benevolence, 
by becoming day bv day a more effective in- 
strument for restoration of health, moral as 
well as physical. Poor as well as rich must 
have no fear of our institutions, nor dread 
being taken to them for treatment. All those 


Volume Thirty, No. 6 


Poor Patients in Hospital Wards 


12 9 


who have been cared for bv ns should return 
to their homes with their feelings of joy 
mingled with regret at leaving us, and with 
a disposition to come back to us, should cir- 
cumstances compel. Moreover, it is necessary 
to interest people in general in our hospital. 
It is not always their fault if they show no 
interest ; they do not know the difficulties of 
our practical problems, nor the facts con- 
cerning our costs of maintenance, and of all 
the benefits which they secure. It is good 
work to keep them informed. 

I beg permission to express a hope that 
this meeting will give special thought to that 
charity which makes us regard the poor man 
as a friend, better still, as a brother. For we 
as Sisters of Charity, besides financial re- 
sponsibilities often very hard to carry, like 
to remind ourselves that we are enlisted in 
the great work which Christ undertook 
toward those whom He regarded as a flock, 
of which He Himself is the Good Shepherd. 


And this flock, looking upon us as conse- 
crated to the service of God, may rest as- 
sured that all interests are understood when 
it falls to our lot to ease bodily suffering and 
to show sympathy with any member of that 
great human family of which we ourselves 
form part. Every grief touches us ; every 
groan lies within our own kingdom ; every 
form of suffering within our proper domain. 

To keep ourselves up to the height of our 
task, we may count upon the help of Provi- 
dence and upon the aid of friends and bene- 
factors, as well as — which goes without say- 
ing — upon the skilled guidance and support 
of the doctors. In St. Mary’s Hospital this 
guidance and support never fails us. These 
gentlemen, be it said in their praise, have 
worked unceasingly in loyal cooperation with 
us, giving us the inspiration of their own 
high ideal and having no goal in sight but 
that of the common good. 


Acta Radiologica, Stockholm* 


19 : 409-504 (Nov. 30) 1938 
*X-Ray Diagnosis of Intestinal Obstruction. A. 
Hoyer. — p. 409. 

Dosage, Duration of Treatment and Reactions in 
Protracted-Fractional Roentgen Treatment, 
with Special Reference to Carcinoma of the 
Upper Air Passages. J. Juul. — p. 433. 

Cancer of the Penis and Its Treatment. C. J. 
Hansson. — p. 443. 

Peptic Ulcer of the Esophagus. F. Norgaard. — 
p. 458. 

Fundamental Property of Planigraphic Image- 
Formation. R. H. De Waard. — p. 465. 

Gastric Svphilis: Two Cases. P. A. Blinkenberg. 
— p. 480. 

Notes on Myeloma. J. Bichel and P. Kirketerp. 
— p. 487. 


X-Ray Diagnosis of Intestinal 
Obstruction 

Hoyer points out that it may be difficult 
to make the clinical diagnosis of intestinal 
obstruction in the first twenty-four hours be- 
cause of the fact that the symptoms typical 
of this lesion may be totally or partly absent. 
The pain generally gives rather indefinite 
data on which to base the diagnosis, as it is 


indistinguishable from colicky pain of other 
causes and it has no typical location. Neither 
does the vomit supply information before the 
vomitous becomes foul. This is a late symp- 
tom, however, and indicates that the situation 
is becoming exceedingly grave. Information 
to the effect that there lias been no passage of 
feces or flatus is of small value during the 
first twenty-four hours. The signs also are 
scarce during the first twenty-four hours. In 
view of these difficulties encountered by the 
clinical diagnosis it was of great importance 
that Ivloiber in 1919 discovered that the 
x-ray diagnosis of intestinal obstruction could 
be made with great certainty at an early 
point of time, without contrast mediums, only 
by x-ray examination with horizontal direc- 
tion of the rays. In this manner he revealed 
the characteristic fluid levels caused by the 
simultaneous presence in the intestine of gas 
and thin intestinal contents. After reviewing 
Ivloiber’s experience with roentgenoscopy in 
Continued on page 11>2 


* Reprinted from The Journal of the American Medical Association, February 4, 1939. 


130 


The Journal of the Maine Medical Association 


Meeting of the New England Oto-Laryngological Society , 
November 15, 1938, at Boston, Massachusetts 

By Weenek Mueller, M. D., Boston, Massachusetts, Abstract Editor 


A Case of Cardiospasm with Autopsy 
Report. Dr. Harry Butler, Bangor, 
Maine. 

A female, aged 29 years, with a history of 
cardiospasm, was referred to the author from 
the Medical Service. Medical examination 
and Roentgen studies had failed to show any 
cause for regurgitation of food over a period 
of 2 years other than fibrosis of the lower end 
of the esophagus. The esophagoscopic picture 
was typical of “cardiospasm.” 

Treatment by bouginage was carried out at 
various times, but with only temporary im- 
provement. After the first attempt at dilata- 
tion the patient complained of sub-sternal 
pain, but showed a normal temperature, 
pulse, respiration, and blood count. After 
bougies and esophagoscopes had been passed 
several times, the Tucker dilator was resorted 
to. A pressure of 5 pounds was used the first 
time. The patient did well, gaining 20 
pounds during the following 2 months. Dur- 
ing this period an afebrile upper left lobe 
inflammation appeared, but cleared up by 
spontaneous absorption. Before discharging 
the patient, the Tucker dilator was used once 
more, this time at a pressure of 8.5 pounds. 
On the same evening the sub-sternal pain re- 
appeared. Within 36 hours the temperature 
rose from normal to 103 degrees, the W. B. 
C. rose to 10,200 and later to 18,000. On the 
fourth post-operative day the roentgenologist 
Reported a shadow suggestive of sub-dia- 
phragmatic abscess. An abscess of the lesser 
omental cavity was evacuated. Two days 
after this the patient died of peritonitis. 
Autopsy revealed a perforation on the pos- 
terior wall of the stomach, about 2 inches be- 
low the cardiac orifice. Another small area 
was nearly perforated. A diagnosis was made 
of spontaneous rupture of the stomach due to 
a weakening of the stomach wall by a previ- 
ously existing pathological condition. The 
author believes that the latter contributed to 
the development of the “cardiospasm.” 


Discussion : Dr. Mosher felt that 8 pounds 
pressure was too much. He has found that 
strictures do not require such high pressure. 

Post-Operative Tonsil Hemorrhage. Dr. 
John R. Uoyes, Brockton, Mass. 

After reviewing the various hemostatic 
procedures of the past and present the author 
describes a method that has yielded him ex- 
cellent results in 126 cases during the past 
18 years. After cleaning out the tonsillar 
fossa and locating the bleeding point, 1-2 cc. 
of a one percent novocain solution, containing 
one minim of adrenalin in each cc. of novo- 
cain, are injected around it. If the bleeding 
point cannot be found it is best to inject vari- 
ous areas. Up to 10 cc. of solution can safely 
be used. The author believes that the mech- 
anism of the hemostasis under this treatment 
is the pressure exerted by the injected fluid 
plus the vaso-constrictor action of the 
adrenalin. 

Discussion : Dr. George L. Tobey cited a 
case of bleeding into the tissues of the soft 
palate. All procedures to stop the hemor- 
rhage had failed. At the time of this discus- 
sion he considered the necessity of having to 
tie the external carotid artery. 

Dr. August L. Beck prefers to place his 
trust in the bi -polar diathermy apparatus. 
Dr. Lyman G. Richards laments the fact that 
so little is known about the cause of post- 
operative bleeding from the tonsillar fossa. 
He had found the bleeding and clotting time 
to be of no help at all. Primary hemorrhage 
can be the fault of the operator, secondary 
bleeding not. 

Precautionary Measures in Paranasal 
Surgery Under Local Anesthesia. 
Dr. W. H. Chaffers, Lewiston, Maine. 

The author cites the case of a young physi- 
cian who was twice treated for an obscure 
painful eye condition. Routine examination 


Volume Thirty, No. 6 


Meeting of the New England Oto-Laryngological Society 


131 


revealed a sensile “tumor” on the border and 
lateral surface of the right inferior turbinate. 
This proved to he a calcium encrusted cotton 
tampon. Finally it was learned that 9 years 
previously the patient had been operated 
upon for a dentigerous cyst of the maxilla 
and that cotton tampons had been placed into 
the nostril of that side. One of these had 
been overlooked and it remained in the nose, 
giving rise to coryza-like symptoms and 
slight respiratory obstruction. Some years 
previously the author, while doing a secon- 
dary Caldwell-Luc operation, removed a cot- 
ton tampon from the antrum. This tampon 
probably necessitated the secondary operation 
by interfering with healing. 

The author stresses the importance of 
thoroughness in history taking regardless of 
whether the patient be layman or physician. 
He also considers it advisable to institute 
tampon counts just as the general surgeon 
insists on sponge counts. 

Applied Biochemistpy in the Etiology 
and Treatment of Clinical Condi- 
tions of the ISTasal Accessory Si- 
nuses. Dr. D. C. Jarvis, Bar re, Yt. 

The author believes that in many cases 
certain foodstuffs can give rise to nose and 
throat conditions with which every nose and 
throat specialist is confronted daily : exces- 
sive watery or muco-purulent nasal secretion, 
enlarged turbinates, and a pharynx with 
large lateral bands and lymph follicles. These 
conditions are, in the author’s opinion, due to 
what he terms “a block in the body process 
of cell oxidation.” The offending foodstuffs 
the author has found to be wheat, graham, 
and buckwheat flour, white and brown sugar, 
and citric acid as found in citrous fruits. 
For these rye flour, oatmeal, cornmeal, honey, 
bananas and apple juice are substituted. For 
the most efficient utilization of these food- 
stuffs in the body cells it is necessary to 
supply oxidizing minerals, such as iodine, 
iron, copper, manganese, and arsenic, all in 
organic form. The mineral content of the 
blood determines the rate at which the blood 
sugar is burned. In the author’s opinion the 
American diet is very low in mineral ash. 
The treatment of such conditions brought 
about by a “block in the body process of cell 


oxidation” is directed first to the establish- 
ment of a proper diet, second to the adminis- 
tration of an oxidizing catalvst in the form 
of insulin. Of this latter the patient is given 
3 unit doses subcutaneously whenever he pre- 
sents himself for examination. In addition 
the patient is instructed to take 3 drops of 
Amend’s iodine solution 20 minutes before 
meals. Under this form of treatment cases of 
acute sinusitis usually clear up in 3 days, 
subacute cases require 10 days, and chronic 
cases 6-12 months. The author cited two 
typical cases which responded promptly 
under the treatment described. 

Discussion : This paper was discussed by 
Drs. Goodell, Meltzer, Mosher, Seaver, and 
Berry, who expressed their appreciation of 
Dr. Jarvis’ work and believe with him that 
there is a great deal in bio-chemistry that is 
worth considering in the work of the oto- 
laryngologist. 

Hearing Aids — By a Wearer of One. 
Miss Elsie L. Staples, Executive 
Secretary, Boston Guild for the 
Hard of Hearing. 

The speaker discussed the use of hearing 
aids from the standpoint of the wearer. She 
strongly advised that hearing aids be resorted 
to before the deafness had progressed too far. 
Most persons receive but little help from a 
hearing aid until the hearing loss amounts to 
from 30-35 percent, but when that point has 
been reached no further delay should be toler- 
ated. Ho otologist should allow his deaf pa- 
tients to struggle along until they have 
stopped trying to hear. At this point the 
speaker related how not one of the otologists 
whom she had consulted for the possible 
treatment of her deafness had called her at- 
tention to the use of lip reading or a hearing 
aid. It was her oculist who did that. The 
somewhat complex psychology of the deaf 
was discussed in some detail. Thus it makes 
a great deal of difference whether or not a 
deaf person hesitates to ask for the repetition 
of sentences or phrases. Some want to carry 
on their wonted activities, other resign them- 
selves to be more or less cut off from the rest 
of their fellow beings. 

The various forms, electric or non-electric, 
of hearing aids were described and discussed. 


132 


The Journal of the Maine Medical Association 


One fact must be borne in mind : there is no 
“best” hearing aid. 1ST ot only must the type 
and degree of the deafness be considered, but 
many other factors come into play to make a 
hearing aid useful to one patient and useless 
to another. A properly fitted hearing aid 
must not only increase the power of the 
sounds transmitted, it must also avoid dis- 
tortion and adventitious noises. Clarity is 
just as important as loudness. The need for 
fighting unethical advertising on the part of 
manufacturers and dealers is obvious, for the 
deaf have always been a ready prey for those 
who promise them relief. The Boston Better 
Business Bureau has recently taken action to 
stop such advertising. Although hearing aids 
can restore the deaf to useful, happy indi- 
viduals, it must be remembered that they 
have definite limitations. They do not raise 
the hearing level to anywhere near the nor- 
mal points. Lip reading must always be 
ready to do its share in filling in the gaps left 
bv the hearing aid, especially in the trans- 
mission of consonants. Finally, the speaker 
reminded the audience of the services ren- 
dered by the Boston Guild for the Hard of 
Hearing as a “clearing house” on all phases 
of deafness. 

Discussion : The paper was discussed by 
Drs. Mosher, MacCready, Hill, and Tobey, 
as being one of the pleasantest on this subject 
ever given and clearing up a great many 
points as to the uses of hearing aids. 

Surgical Technique for tite Conserva- 
tion of the Hearing in Chronic 
Mastoiditis. Dr. J. Morrisset Smith, 
Hew York City. By Invitation. This 
paper appeared in full in The Laryngo- 
scope for July, 1938. 

The author believes that it is impossible to 
deal with all cases of chronic mastoid infec- 
tion by the use of one type of operation. The 
degree of necrosis encountered in the differ- 
ent cases should determine the surgical tech- 
nique employed. Four types of procedure are 
recommended. 


The complete simple mastoid operation is 
indicated where the removal of the drum and 
ossicles is not necessary. It consists essen- 
tially of the usual simple mastoidectomy plus 
a wide exposure of the attic by dissection of 
the bone at the root of the zygoma. The 
middle ear is cleaned of polypi or granula- 
tions through the external canal. The after 
treatment consists of cleansing irrigations 
from the mastoid wound as well as from the 
canal. This technique, which is especially in- 
dicated in young children, will frequently 
result in a dry ear with the preservation of 
valuable hearing. 

The second technique differs from the first 
in that the incus is removed in order to facili- 
tate the removal of granulations from the 
attic. The author claims that the removal of 
the incus has remarkably little effect upon 
the hearing. 

In cases where the hearing in the other ear 
has been lost, or in the presence of an exten- 
sive bilateral infection where the preserva- 
tion of the hearing may be vitally important, 
the third technique is employed. This the 
author calls the “new radical operation.” It 
is devised to care for some of the cases re- 
quiring removal of the malleus and the incus 
without, however, necessitating the complete 
radical operation. The technique is as in the 
second type except for the removal of the 
malleus as well as the incus and the remain- 
ing portions of the drum membrane. The 
external canal and its lining are left intact. 
Idie after treatment includes irrigations and 
careful drainage. In the author’s opinion 
this operation will be successful in many 
cases in which formerly the complete radical 
operation would have been used. 

The complete radical operation is resorted 
to in complicated cases or where one of the 
above procedures has failed to check the prog- 
ress of the disease. Ossiculectomy is not ad- 
vised since it leaves the operator as well as 
the patient in the dark concerning the extent 
of the necrosis beyond the attic. 


Volume Thirty , No. 6 


Editorial 


133 


Editorial 

The Annual Session 


Today, more than ever before, in the face 
of the many rapidly changing conditions 
governing the practice of medicine, science 
progressing so rapidly that even workers in 
highly specialized fields regard frequent re- 
views and conferences as obligatory do our 
National and State meetings become more 
essential. The problems that confront us, 
economic and scientific, are increasing. A 
former president of the Maine Medical Asso- 
ciation feels that organized medicine is on 
the defensive and must meet the challenge of 
the widespread and often unfair propaganda 
directed against it by those with far from 
selfish interests. 

Many things that we know to be without 
justification are causes of concern and be- 
wilderment to the public we serve. The media 
of platform, press and radio must be utilized 
to keep the public informed of matters per- 
taining to their health and safety. 

Each County Society has one or more mem- 
bers in the House of Delegates. If mandates 
can be issued to the profession of the State 
they must come through the general assem- 
bly of your delegate body, It. and it alone, 
is responsible for the pronouncements it lays 
down and the assignment of duties to those 
holding official positions. The definite prob- 
lems of each County Society varies many 
times from those of its neighbors ; they be- 
come, and are our general concern. 

The official program, carried in the present 
issue, merits sincere appreciation of the work 
of the Scientific Committee and offers much 
in the way of opportunity for the discussion 
of problems of interest and importance. Most 


fortunate are we in having as our speaker at 
the annual Banquet, the editor of the Journal 
of the American Medical Association ; Dr. 
Morris Fishbein. The threat of “socialized 
medicine”, dictated by and from Washing- 
ton, cannot be dismissed as an idle threat 
and something that cannot happen here. It 
can and it HAS, and no one is more capable 
of presenting its fallacies, dangers and in- 
justice than our distinguished guest. Not 
only is he conversant with the facts but is 
most competent to advise the ways and means 
to avert further encroachments and bureau- 
cratic control. 

Not only do our annual sessions offer re- 
newed opportunities for needed accomplish- 
ments and the discussions of problems of 
great importance to every practitioner of 
medicine but they also afford a most neces- 
sary recreational diversion. As has been 
stated before — the financial burden on the 
State Association is materially lessened bv 
the exhibitors who have become no minor 
part of our meetings. From an educational 
standpoint these exhibits are most important. 
They bring before us the advances rapidly 
being made and competent men are available 
to show and discuss the merits of their prod- 
ucts of necessity in our daily work. As an 
appreciation of their being with us can only 
be shown by attendance at the exhibits — let 
us manifest it collectively and personally. 

To the delegates from our sister States, a 
most hearty and fraternal greeting is ex- 
tended. To our own members and visiting 
friends our sincere thanks for the excellent 
program provided. 


134 


The Journal of the Maine Medical Association 



WILLARD H. C BUNKE C R, M. D., P. A. G. S. 

j President Maine Medical Association, 1938 - 1939 


Volume Thirty, No. 6 


The President’s Page 


135 


The President's Page 


To the Members of the Maine Medical Association: 

Now that the time has finally arrived for me to write my last Presi- 
dent’s Page and sever my connections with an organization with which I 
have been closely associated for several years, I find it difficult to express 
my gratitude to the officers of our Association for their friendly coopera- 
tion and willingness to assist me during my year as President. 

An equal amount of gratitude goes to the individual members of the 
different committees and last, hut by no means least, I wish to pay a tribute 
to our Assistant Secretary, Mrs. Esther Kennard, for her efficient service 
during the year. 

As President, I have had my share of difficulties which could in no 
way be avoided, but these have been overshadowed by many pleasant 
occasions. 

Certainly any President of this Association who retires from office 
with the Dove of Peace still resting on his shoulder is entitled to very 
little credit. 

Without appearing presumptions I can truthfully say that we have had 
a very satisfactory year. 

We have upheld the rights of our State Association and with the 
excellent cooperation of the different State Organizations closely allied 
with us have passed through a legislative year unharmed. 

I feel confident that the affairs of our Society can safely be entrusted 
to my successor, George L. Pratt, M. D., because of my personal acquaint- 
ance with him and my knowledge of his excellent qualities of fairness and 
determination. 

Therefore, in closing, I can do no better than to wish him all possible 
success in his undertaking and to every member of our Association, I 
extend my thanks for their friendship and support during the year. 

Willard H. P>unker, M. D., 
President, Maine Medical Association. 


136 


The Journal of the Maine Medical Association 


Graduate Education 


Commonwealth Fund Postgbaduate 
Medical Fellowships 

The Commonwealth Fund of New York 
City is making available fellowships in the 
subjects indicated below to members of the 
Maine Medical Society, to be given at Har- 
vard Medical School, Courses for Graduates, 
25 Shattuck Street, Boston, Massachusetts. 

Medicine , given at the Massachusetts 
General Hospital, Peter Bent Brigham 
Hospital or Boston City Hospital. A group 
of at least six must take the course at one 
time. Such a group may be made up from 
any or all of the four states in which the 
fellowships are offered ; namely, Maine, 
New Hampshire, Vermont or Massachu- 
setts. 

Pediatrics , given at the Children’s Hos- 
pital. Not more than six may take the 
course at one time. 

Obstetrics , given at the Boston Lying- 
In Hospital. Not more than six may take 
the course at one time. 

Office Surgery, given at the Boston City 
Hospital ; designed for physicians engaged 
in general practice; subjects studied are 
surgical problems met in the office ; instruc- 
tion in the out-patient department. A 
group of at least eight must take the course 
at one time. 

Fellowships are for one month. Preference 
will be given those who take the course in 
medicine, for a second month in medicine or 
in obstetrics, pediatrics or office surgery, 
when fellowships are available during suc- 
ceeding years. The stipend is $250.00 plus 
tuition and actual travelling expenses. 

Qualifications : Applicant must be a grad- 
uate of a grade “A” medical school ; a mem- 
ber of the Maine Medical Society in good 
standing ; must have been in practice at least 
five years and should preferably be under 
forty-five years of age ; and must be a resident 
of a community of less than 10,000 popula- 
tion. Application blanks may be obtained 
from the Division of Public Health, the 
Commonwealth Fund, 41 East 57th Street, 


New York City, or from the Secretary of the 
State Medical Society. 

The Bingham Associates Fund 

The Bingham Associates Fund is offering 
the following courses, in addition to the one- 
month course in General Medicine. 

Obstetrics and Gynecology — 1 Month. 

This work will be conducted under the 
control of the Faculty of Tufts College Medi- 
cal School. The facilities of the New Eng- 
land Medical Center, the Joseph H. Pratt 
Diagnostic Hospital, The Boston Dispensary 
and the Evangeline Booth Maternity Hos- 
pital will be utilized. 

Pediatrics - — 1 Month. 

Four courses are offered; during the 
months of November, 1939, January, Feb- 
ruary and March, 1940. A maximum of four 
men can be accommodated in each course. 
This work will be conducted under the con- 
trol of the Department of Pediatrics, Tufts 
College Medical School, and the entire facili- 
ties of the Department will be utilized inso- 
far as may be feasible. These consist of the 
foil owing institutions: 

The Children’s Department of the Bos- 
ton Dispensary, where ambulatory patients 
are available. 

The Boston Floating Hospital, where 
bed patients from birth to twelve years are 
admitted with all types of diseases, except 
contagion. 

The Evangeline Booth Maternity Hos- 
pital, utilized to demonstrate diseases of 
and care of the newborn. 

The South Department of the Boston 
City Hospital. 

The Charles V. Chapin Hospital, Provi- 
dence, Rhode Island (both available for the 
study of contagious diseases). 

The New England Deaconess Hospital, 
where a large group of diabetic children 
are under supervision and care. 

A llergy- — 40 Hours. 

Courses will be given on receipt of at least 
six applications. 


Volume Thirty, No. 6 


Graduate Education 


137 


The course is designed to familiarize the 
general practitioner with the recent advances 
in the field and give him training in the 
newer laboratory procedures. Preparation of 
allergens and the latest development in test- 
ing will be taken up. The mornings will be 
devoted to the didactic lectures and work in 
the clinics. The afternoons will be utilized 
for laboratory training. 

Hematology — 40 Hours. 

Courses will be given on receipt of at least 
six applications. 

The course is designed to acquaint the 
general practitioner with the recent practical 
advances in the field of blood diseases. The 
mornings will be devoted to conferences and 
laboratory training, the afternoons to didac- 
tic lectures on the blood dyscrasias and their 
treatment. 

Proctology — 40 Hours. 

Courses will be given on receipt of at least 
six applications. 

Utilizing the out-patient clinics in the Bos- 
ton Dispensary, the Massachusetts General 
Hospital, the Cambridge Hospital and the 
Newton Hospital. Study of the anatomy, 
physiology and pathology of the anus, rectum 
and colon, correlated with the history, exami- 
nation, diagnosis and treatment of such con- 
ditions will be given. Lectures will be illus- 
trated by lantern slides. It is preferable that 
the enrollment be limited to four students 
during any one week. 


In addition to the above courses the list 
which follows indicates the subjects in which 
courses are available or in preparation for 
presentation in the near future : 

Diabetes 

Endocrinology 

Electrocardiography 

Cardiology 

Genito-ur inary diseases 
Diseases of the chest 
G astro-enterology 
Dermatology 

Fellowships covering these courses are 
available to members of the Maine Medical 
Association. Each one-month Fellowship car- 
ries an honorarium of $250.00. Rooms and 
meals are available for Fellows at reduced 
rates, in the New England Medical Center. 
Each one- week Fellowship carries an hon- 
orarium sufficient for expenses. 

Application for Fellowships should be 
made to Samuel Proger, M. D., 25 Bennet 
Street, Boston, Mass. 

Further information regarding opportuni- 
ties for Graduate Education may be obtained 
from the Committee on Graduate Education. 
Frederick T. Hill, M. I)., Waterville. 
Julius Gottlieb, M. D., Lewiston. 
Norman IT. Nickerson, M. D., Greenville. 
Flank II. Jackson, M. D., Houlton. 
Eugene E. Holt, NT. D., Portland. 


Report of the Necrologist, 

1938-1939 


Maine Medical Association deceased mem- 
bers since June, 1938: 

Abbott, Edville Gerhardt, Portland 
Badger, Forrest Hartley, Winthrop 
Bragdon, Frederick Augustus, Springvale 
Cummings, Eclson S., Portland 
Elliott, Gilbert M., Brunswick 
Foss, Clarence W. P., Brunswick 
Goodwin, Harold Merle, Bangor 
Hanlon, Orville Leon, Mexico 
Marshall, Sumner Bradbury, Alfred 


Moulton, Will is Bryant, Portland 
Plumer, Herbert Hall, Union 
Powell, Lester Lovett, Portland 
Randall, Jesse A., Old Orchard Beach 
Simons, Ralph D., Gardiner 
Trefethen, William J., Wilton 
Weeks, George W., Cornish 
Woodman, Daniel Nash, North Haven 

Respectfully submitted, 

Frederick R. Carter, 

Necrologist. 


138 


The Journal of the Maine Medical Association 


Report of the Secretary-Treasurer 


As Secretary, T am pleased to submit the 
following annual report : 

There are 691 active members in good 
standing in the Association, and 25 honorary. 
We have added to our roster 41 new members 
and have lost 17 through death 

In accordance with our By-Laws, Chapter 
VIII, Section I, we dropped, in April, 16 
members for non-payment of dues. Three 
have been reinstated. 

In accordance with a vote of the Council, 
that the unexpended income from the Thayer 
Library Fund be used to purchase books for 
the Spalding Memorial Library at the Maine 
General Hospital, Portland, the following 
books have been purchased at a cost of 
$101.80 and presented to the Library: 

Davis Gynecology and Obstetrics 

Cabot’s Urology 

Boyd’s Textbook of Pathology 

Bethea Materia Medica 

The Technic of Medication 

Forkner’s Leukemia and Allied Disorders 

Ivey and Conwell Fractures 

Year Book of Obstetrics and Gynecology 

Fillers for Brenneman’s Pediatrics 

At the request of the Legislative Commit- 
tee the Council authorized the President and 
Secretary to guaranty Mr. Locke, Attorney, 
the funds necessary to cover matters of in- 
terest to the Medical Profession at the 1939 
Legislative Session. The Association has, 
therefore, paid Mr. Locke, for services and 
incidental expenses, a total of $1,034.92. 

The 1938 fall clinical session was held in 
Lewiston, November 3rd and 4th. Interest- 
ing and instructive programs were presented 
by the Central Maine General Hospital and 
the Saint Mary’s General Hospital. 


The 87th annual session will be held at 
the Poland Spring House, June 25th, 26th, 
and 27th. The report of the Council for the 
year will be presented by the Chairman, Dr. 
Thomas A. Foster, at the first meeting of the 
House of Delegates, Sunday, June 25tli, at 
4.30 P. M. 

The Association will have the privilege of 
presenting Fifty-Year Service Medals to Drs. 
Charles B. Sylvester, Portland ; Gustav A. 
Pudor, Portland; Bernard A. Bailey, Wis- 
casset; and Henry I. Durgin, South Eliot; 
at its annual session banquet, Tuesday eve- 
ning, June 27th, at 7 o’clock. In view of the 
fact that Gilbert M. Elliott, who died April 
1st, would have been eligible to receive a 
medal at this meeting, the Council has voted 
that the Association present Mrs. Elliott with 
Dr. Elliott’s medal. 

The reservations for Commercial Exhibits 
are the largest ever and I sincerely hope that 
every member will show his appreciation of 
their support by making it a special point to 
visit these exhibits. 

Your secretary wishes to express his appre- 
ciation for the cooperation of the county 
secretaries, councilors and other officers of 
the Association in carrying on the work of 
the Association. 

The books of the Association and Jottrnad 
were closed and audited as of May 31, 1939. 
The Auditor’s Report will be found on Page 
151. 

Respectfully submitted, 

Frederick R. Carter, M. D., 

Secre ta ry-Tre asurer. 

May 31, 1939. 


Only Six Per Cent — Of 8,654 veterans of 
the World War hospitalized for tuberculosis 
in six months, 71% were far advanced, 23% 
moderately advanced and only 6% were min- 
imal. Matson, R. C., U. S. Yet. Ad. Phys. 
Conf., 1938. 


Self -Protected — Few physicians die of tu- 
berculosis despite the fact that they are con- 
stantly exposed to it. Knowledge defends 
them as it may yet defend other groups in 
the population when properly educated in 
self-protection. 


Volume Thirty, No. 6 


Councilor Reports 


139 


Councilor Reports 


Report of Councilor , First 
District 

To the Officers and Members of the Maine 
Medical Association: 

The Medical Societies of York and Cum- 
berland Counties are active and well organ- 
ized. The York County Society lias a paid- 
up membership of forty-six and one honorary 
member. During the year three physicians 
were admitted to membership ; Dr. W. L. 
Morse of Springvale, Dr. Kenneth Cuneo of 
Kennebunk, and Dr. Carl E. Richards of 
Alfred, and four members were lost by death : 
Dr. Frederick A. Bragdon of Springvale, 
Dr. Jesse A. Randall of Old Orchard, Dr. 
George Weeks of Cornish and Dr. Sumner 
B. Marshall of Alfred. 

Quarterly meetings have been well at- 
tended, twenty-two being present at the last 
meeting in Kennebunk. 

During the summer, York and Cumber- 
land had a joint meeting at Long Island in 
Casco Bay. In the autumn the Society held 
a meeting in Sanford at the Henrietta D. 
Goodall Memorial Hospital, at which time 
Dr. Bragdon of Springvale received birth- 
day greetings from the members. Dr. Brag- 
don informed and entertained the members 
of the Society with reminiscences of his color- 
ful practice in York County, and the Presi- 
dent, Dr. Bunker, addressed the meeting, 
emphasizing the advantages of sound organi- 
zation, high standards of practice and ethics 
of consultations. 

The Annual Meeting in January was held 
at The Normandie in Scarboro. Dr. Dana 
B. Mayo of Eliot was elected President; 
Dr. W. T. Roussin of Biddeford, Vice Presi- 
dent, ; Dr. Charles Kinghorn of Kittery was 
re-elected to fill the position of Secretary, 
which he has filled so adequately for many 
years; Censors: Dr. S. A. Cobb, Sanford, 
Dr. Paul S. Hill, Jr., Saco, Dr. E. C. Cook, 
York; Delegates to State Society: Dr. C. W. 
Kinghorn, Dr. S. A. Cobb ; Alternates : Dr. 
J. II. MacDonald, Kennebunk, Dr. W. H. 
Kelly, Sanford. A panel of Maine physicians 


under the Chairmanship of Dr. F. T. Hill 
of Waterville discussed “Pneumonia. ” 

The Spring meeting was held at The 
Tavern in Kennebunk. Dr. Kinghorn and 
Dr. Carl Corson of Portland were the speak- 
ers, Dr. Kinghorn presenting some lantern 
slides of ear conditions and Dr. Corson speak- 
ing about “Fractures.” 

The Cumberland County Medical Society 
boasts a membership of 172 active members, 
and five honorary. Vine physicians have been 
admitted to membership and nine members 
have been lost, by death. This Society has 
held five meetings including the Clam Bake 
at Long Island with the York County So- 
ciety. At the October meeting, Dr. Roland 
Moore presented moving pictures of obstetri- 
cal procedures and discussed the problems 
involved. Dr. Bunker visited the Society and 
addressed the members with his usual vigour 
and straightforwardness. 

At the Annual Meeting in December, Dr. 
George A. Tibbetts was elected President; 
Dr. E. IT. Drake, Vice President ; Dr. Har- 
old V. Bickmore, Secretary; Dr. Henry M. 
Swift, Counselor for 3 years. Delegates : Dr. 
L. A. Brown, Dr. W. D. Anderson, Dr. J. C. 
Oram, Dr. F. A. Smith, Dr. Ralph A. 
Heifetz, Dr. I). H. Daniels. Dr. Maxwell 
MacDonald of Boston spoke on “Emotions 
and Bodily Changes.” 

On January 27tli, the Society had the 
privilege of hearing our Hew England 
Trustee of the American Medical Society, 
Dr. Roger I. Lee, speak to them on “The 
Doctor’s Dilemma When and If the Govern- 
ment Goes into the Practice of Medicine in 
a Big Way.” 

In March, a panel of Maine physicians 
under Chairmanship of Dr. E. E. Holt, Jr., 
discussed “Cardiovascular Disease.” 

The Society conducted clinics at the local 
hospitals before the evening meetings and the 
attendance at meetings and clinics indicates 
a lively interest in the activities of the 
Society. 

Respectfully submitted, 

Thomas A. Fostek, 
Councilor, First District. 


140 


The Journal of the Maine Medical Association 


Report of Councilor , Third 
District 

Knox and Sagadahoc County Medical So- 
cieties have held the usual number of regular 
meetings during the year and have been very 
well attended. Many of the programs have 
been of the post-graduate type, bringing 
about much discussion, making them interest- 
ing and instructive. 

The good-fellowship which exists through- 
out this district is 100% and helps to make 
the people feel that they receive adequate 
medical care at home. It is indeed gratify- 
ing to report that several of the members have 
taken advantage of post-graduate courses dur- 
ing the past year. 

Respectfully submitted, 

Wm. Ellingwood, 
Councilor , Third District. 


Report of Councilor , Fifth 
District 

Fifth District — Washington and Hancock 
Counties. The year has been marked by prog- 
ress toward a renewed interest in County 
Societies and better attendance. 

The definite and uncompromising policies 
of the President of the Maine Medical Asso- 
ciation have given members a faith in the 
potential value of organized medicine. 

Uniting with Waldo County, three meet- 
ings were held under the direction of authori- 
tative clinicians furnished by the Maine Med- 
ical Association through the Committee on 
Graduate Education. These panel discus- 
sions were valuable and satisfactory methods 
of diffusing knowledge and stimulating 
further study. Members of this district hope 
to see this plan in force next year. During 


the year, the Hancock County Medical So- 
ciety has lost to Forth Adams, Massachusetts, 
Doctor Pliny Allen. Doctor Allen was a well- 
trained, liberally educated young man of the 
type most needed in Maine. Doctor Mac- 
Donald, Machias, has resigned from the State 
Department of Health and Welfare and 
returned to Machias. 

Respectfully submitted, 

R. Bliss, M. D., 
Councilor , Fifth District. 


Report of Councilor , Sixth 
District 

The three Societies have held their usual 
quota of meetings, some of which I was able 
to attend. Penobscot Society is to be com- 
plimented on its programs, and I was sorry 
I could not be present at all of them. The 
Society deserves much credit for bringing 
many outstanding ont-of-State men here, so 
that we can hear their views on various medi- 
cal and surgical problems. 

Piscataquis Society also had some good 
meetings, the joint meeting at which they en- 
tertained the other Societies being outstand- 
ing. Doctor Aldrich’s talk on burns was 
exceptional and 1 am very sorry more of our 
members could not have heard it. 

Aroostook Society held the usual two meet- 
ings, which were well attended. I think it 
would be a step in the right direction if the 
Aroostook Society could see its way to hold 
at least four meetings a year, and judging 
from the interest shown in the 1038 meetings, 
I feel such a program could be carried out 
successfully. 

Respectfully submitted, 

P. L. B. Ebbett, M. D., 
Councilor, Sixth District. 


Volume Thirty, No. 6 


County News and Notes 


141 


County News and Notes 


Cumberland 

Portland Medical Club 

The regular monthly meeting was held at the 
Columbia Hotel, Tuesday evening, March 7th, at 
8.15 P. M. Thirty-two members and two guests 
were present. 

The papers of the evening dealt with Gastro- 
intestinal Disorders of Infancy and were as 
follows : 

Hypertrophic Pyloric Stenosis, by Dr. E. S. 
Lothrop; Strictures of the Esophagus, by Dr. G. 0. 
Cummings; Pylorospasm and Gastro-enterospasm, 
by Dr. F. P. Webster; Non-Ohstructive Vomiting 
in Infancy, by Dr. T. A. Foster. 

Alice Whittier, Secretary. 


The regular monthly meeting was held at the 
Columbia Hotel, Tuesday evening, April 4th, at 8.15 
P. M. Thirty-one members and two guests were 
present. 

Dr. E. Allan McLean was elected to membership. 

The general scientific subject for the evening was 
The Liver. Speakers and their subjects were: 

Physiology of the Liver and Diseases of the 
Liver, Dr. D. H. Daniels; X-Ray Aspect of Diseases 
of the Biliary Tract, Dr. L. T. Thaxter; Pathology 
of the Liver, Dr. Mortimer Warren; Bio-Chemistry 
of the Bile, Dr. W. D. Anderson; Cholecystitis and 
Cholanzitis, Dr. G. A. Tibbetts. 

Alice Whittier, Secretary. 


Kennebec 

A meeting of the Kennebec County Medical 
Association was held at the Veterans’ Administra- 
tion, Togus, Maine, on Thursday, May 18, 1939. 

Clinical Session at 5.00 P. M., which was pre- 
sided over by Leon D. Herring, M. D., President. 

1 —Aortic Aneurism Simulating Pneumonia, H. 
T. Perkins, M. D.; 2 — Glossopharyngeal Cyst, H. A. 
Goalwin, M. D.; 3 — Massive Collapse of Lung, Na- 
than Rosenberg, M. D.; 4 — Presentation of Uro- 

logical Cases, F. T. Williams, M. D.; 5 — Gastroje- 
juno Colic Fistula. N. H. Badaines, M. D.; 6 — Some 
Studies in Bone Grafts, J. E. Wheeler, M. D.; 7 — 
Lantern Slide Demonstration of Certain Cardiac 
Abnormalities, M. T. Moorehead, M. D.; 8 — Strep- 
tococcic Pneumonia, A. L. Fitzporter, M. D. 

Dinner at 6.30 P. M., which was followed by a 
business meeting. 

Minutes of the last meeting were read and 
approved. 

Nathan Rosenberg, M. D., Togus, Maine, was 
elected to membership. 

The guest speakers were Charles P. Shelton, 
M. D„ Boston, Mass., Assistant Obstetrician, Boston 
Lying-In Hospital, whose subject was Bleeding 
During Pregnancy , and Joseph Shorten, M. D., 
Boston, Mass., whose subject was Treatment of 
the Fractures of the Neck of the Femur, which 
was illustrated by X-rays. Both papers were very 
interesting and were followed by a general dis- 
cussion which brought out many points of interest. 

There were thirty-eight members and guests 
present. 

Respectfully submitted, 

Frederick R. Carter, M. D., 

Secretary. 


Knox 

The scheduled meeting of the Knox County 
Medical Association was held at the Copper Kettle, 
Rockland, April 11, 1939. Minutes of last meeting 
were read and approved. Letters from Doctor 
Carter were read and discussed, as was also a 
letter from Doctor Webber of Lewiston concerning 
telephone rates and listing of physicians. 

According to notice from the Maine Medical 
Association concerning the loss of membership for 
nonpayment of dues by April 1st, two members 
were declared dropped from the Association. 

A discussion by Doctor Carswell of conditions at 
the Camden Hospital under present regulations, 
and the resignation of the nurses and physicians 
working there to become effective April 26, 1939, 
unless changes were made, was heard. Voted to 
endorse action taken by physicians. 

Doctor Thannhauser of Boston, the guest speaker, 
gave a very brilliant and instructive talk on 
Vitamin Deficiencies. Much interest was evident, 
and practical points of treatment were stressed. 
Doctor Coombs of Waldoboro showed pictures of 
Vitamin C deficiency which were positive proof of 
a vitamin lack among certain groups. 

Discussions by Doctors Foss, Soule and Brown 
were listened to with much interest. 

A. J. Fuller, M. D., 

Secretary. 


New Members 

Androscoggin 

Jean Bousquet, M. D., Lewiston. 

S. E. Saivyer, M. D., Lewiston. 


Kennebec 

Nathan Rosenberg, M. D., Togus. 


Notice 

National Tuberculosis Association 

The 35th annual meeting of the National Tuber- 
culosis Association will be held in Boston, under 
the local chairmanship of Dr. Reginald Fitz, and 
which marks the first time that the association 
has met in New England in twenty-one years. The 
headquarters will be at the Hotel Statler, at which 
all meetings will be held, except the clinics which 
are indicated on the program. The dates of the 
meeting are from June 26-29 inclusive and six 
medical clinics have been planned, all of them on 
Wednesday afternoon. June 28, from 2 to 4.30. The 
clinics are open to all physicians attending the 
meeting but admission will be by ticket only. 
Reservations for the many and important interest- 
ing clinics can be made by writing to Dr. Fred- 
erick T. Lord, 305 Beacon Street, Boston. Dr. Lord 
will send interested physicians a program of the 
entire meeting and since the seating capacity of 
all of the amphitheaters is limited early applica- 
tion for tickets is suggested. 


The Journal of Maine Medical Association 


142 


Necrology 


Jesse A. Randall, M. I)., 

1863-1938 

Doctor Jesse A. Randall died at his home at 
Old Orchard Beach, Maine, November 28, 1938. 
Born at South Limington, Maine, December 6, 
1863, the son of Noah and Susan Huntress Ran- 
dall, he was graduated from Bowdoin Medical 
College in the class of 1888. 

Doctor Randall first set up practice in Newfield, 
Maine, where he remained for two years. He then 


went to South Waterboro for two years. In 1893, 
he came to Old Orchard Beach where he remained 
until his death. In his many years of service he 
was highly respected and deeply loved by all who 
had the good fortune to meet him. He was a 
member of both the York County Medical Society 
and the Maine Medical Association and served 
each to the fullest extent. In June, 1938, he was 
awarded a medal by the Maine Medical Associa- 
tion in recognition of his fifty years’ faithful and 
unselfish service to the people of his community. 
His death leaves a deep sorrow in the hearts of 
men. 


Continued from page 129 


100 cases showing* acute abdominal symp- 
toms, the author describes and illustrates the 
x-ray symptoms of intestinal obstruction. 
When an occlusion takes place, the immedi- 
ate result is an accumulation of thin intesti- 
nal contents in the oral direction, whereas 
anally to the occlusion the intestine is more 
or less completely emptied. There is in- 
creased peristalsis. The intestine makes every 
effort to pass the obstruction. Not infre- 
quently patients with obstruction of the small 
intestine have spontaneous defecation shortly 
after the onset of the pain. Next conies an 
abnormal fermentative process of the intesti- 
nal contents with development of gas. This 
supplies conditions for the formation of fluid 
levels which, according to Kloiber, com- 
mences two or three hours after the onset of 
the attack. In mechanical ileus the fluid 
levels are usually visualized in two segments 
of the same coil at different heights. Fluoro- 
scopic examination may demonstrate how the 
fluid levels rise and fall. This symptom is 
an important aid in the differential diagnosis 
between mechanical and paralytic ileus. In 
paralytic ileus the peristalsis has ceased and 
the fluid levels are stagnant. The coil of in- 
testine lying immediately proximal to the 
obstruction, the so-called prestenotic coil, fre- 
quently presents a peculiar condition. The 
peristalsis here is particularly strong. The 


coil rises in the abdomen in the form of a 
reversed U. It has a stiff appearance. The 
tonus seems to be stronger than in the other 
dilated intestines. If an entire coil of the 
small intestine is shut off from the intestinal 
tract, both segments being strangulated, this 
coil becomes greatly dilated by gas and is 
easily recognizable in the roentgenogram. At 
the same time this supplies the accurate 
topical diagnosis, which is represented clini- 
cally by the “hypogastric football" (Wahl 
balloon symptom). The author further men- 
tions a roentgenologic symptom which, in his 
opinion, is of great importance to the diag- 
nosis. This is the more or less complete ab- 
sence of gas from the large intestine in the 
presence of obstruction of the small intestine. 
The author says that at the surgical depart- 
ment of his hospital x-ray examination is 
now employed in all cases of suspected in- 
testinal obstruction. The material available 
so far includes forty-six cases. In all cases 
the x-ray examination supplied a correct re- 
ply as to whether or not an intestinal obstruc- 
tion was present. In a majority of cases the 
site of the lesion could be given. The mor- 
tality from intestinal obstruction has de- 
creased considerably subsequent to the 
adoption as a routine method of the x-ray 
examination of abdominal cases in which in- 
testinal obstruction is suspected. 


P R □ G R A M 


8 7 1 k ANNUAL SESSION 


"MAINE "MED I SAL ASSOCIATION 


June 25, 26, 27, 1939 
Poland Spuing House 

Poland Spring, Maine 


PROGRAM ARRANgED 

by the 

SCIENTIFIC COMMITTEE 



STEPHEN A. COBB 

Ghaivman 


The Journal of the Maine Medical Association 


144 


Jn.embevs 

SCIENTIFIC COMMITTEE 




FREDERICK R. GARTER, Secretary 



MORTIMER WARREN 




Volume Thirty, No. 6 


Prog 


ram 


145 


INFORMATION 

Registration headquarters will be in the Lobby 
of the Poland Spring House. Every member and 
guest is requested to register promptly on arrival. 

A telephone has been installed at the registra- 
tion desk to facilitate the handling of emergency 
calls. All Emergency Calls should be referred to 
the registration desk. To insure prompt and effi- 
cient service physicians expecting emergency or 
urgent calls will please inform the attendants at 
this desk. (Telephone Number Poland 35.) 


All papers read before this Association shall be 
its property, for publication in The Journal of 
the Maine Medical Association, and ichen read 
shall be deposited with the Secretary. 


PROGRAM 

SUNDAY, JUNE 25, 1939 

4.30 P. M. 

First Meeting of the House of Delegates. 

8.30 P. M. 

Entertainment for the Doctors and- their wives, 
by a nationally known prestidigitator. 

MONDAY, JUNE 26, 1939 
Morning Session 

9.30 A. M. -12.00 M. 

Conferences 

I 

EYE 

S. Judd Beach, M. D., 

Portland, Me., Chairman 

External Diseases of the Eye, 

M. J. King, M. D., Boston, Mass. 
Glaucoma, Paul Chandler, M. D., Boston, Mass. 

II 

PATHOLOGICAL 

Mortimer Warren, M. D., 

Portland, Me., Chairman 

1. Demonstration of Case of Lympho Sarcoma, 

Herbert Thompson, M. D., Bangor, Me. 

2. Review of Findings of State Pneumococcus 

Typing Program, 

Arch H. Morrell, M. D., Augusta, Me. 

3. Coronary Artery Injection Studies, 

Julius Gottlieb, M. D., Lewiston, Me. 

4. Lesions of the Skin with Lantern Slide 

Demonstration, Leon Babalian, M. D., and 
Mortimer Warren, M. D., Portland, Me. 

III 

SURGICAL 

Carl M. Rorinson, M. D.. 

Portland, Me., Chairman 

Round Table discussion of Post-Operative Com- 
plications. 

1. Infections, 

George A. Tibbetts, M. D., Portland, Me. 

2. Urinary Complications and Water Balance, 

C. Harold Jameson, M. D., Rockland, Me. 

3. Post-Operative Chest Conditions, 

William Cox, M. D., Lewiston, Me. 

4. Paresis and Intestinal Obstruction, 

Harrison L. Robinson, M. D., Bangor, Me. 


5. Phlebitis and Parotitis, 

Carl H. Stevens, M. D., Belfast, Me. 

6. Transfusion and Blood Banks, 

Ralph L. Reynolds, M. D., Waterville, Me. 

IV 

ANESTHESIA 

Gilbert Clapperton, M. D., 

Lewiston, Me., Chairman 

1. Technique in Endotracheal Anesthesia 

with Detailed Illustration, 

Gilbert Clapperton, M. D., Lewiston, Me. 

2. The Present Status of Intravenous Anes- 

thesia, 

Wedgewood P. Webber, M. D., Lewiston, Me. 

3. What the Physician-Anesthetist Offers the 

Surgeon and Patient Today, 

George E. Young, M. D., Skowhegan, Me. 

4. Post-Operative Pulmonary Complications 

and Their Treatment, 

S. David Daniels, M. D., Lewiston, Me. 

5. Pre-Anesthesia Medication with Special 

Reference to the Basal Anesthetics, 

Edwin M. Fuller, Jr., M. D., Bath, Me. 

6. Cyclopropane Anesthesia, 

Maurice E. Lord, M. D., Skowhegan, Me. 

V 

MEDICAL 

E. C. Cook, M. D„ 

York, Me., Chairman 

Communicable Diseases 

1. The Pneumonia Problem in Maine, 

Roscoe L. Mitchell, M. D., 
State Board of Health 

2. Scarlet Fever and its Treatments, 

Charles B. Popplestone, M. D., Rockland, Me. 

3. Infantile Paralysis, Present Status, 

Lloyd Bishop, M. D., Portland, Me. 

VI 

OBSTETRICAL 

L. H. Smith, M. D., 

Winterport, Me., Chairman 

1. Rural Obstetrics: Some Statistics Perti- 

nent to Deliveries in the Home, 

L. H. Smith, M. D., Winterport, Me. 

2. Surgical Obstetrics with Special Attention 

to Symptoms and Treatment of Pla- 
centa Praevia, 

Walter F. W. Hay, M. D., Portland, Me. 

3. The Ideal Hospital Obstetric Service, 

Clarence Emery, M. D., Bangor, Me. 

VII 

PEDIATRICS 

Clair S. Bauman, M. D., 

Waterville, Me., Chairman 

Some Pediatric Problems of the Respiratory 
Tract, 

Francis McDonald, M. D., Boston, Mass., 
Asst. Prof., Tufts Med. School, Guest Speaker 


Luncheon 

12.30 P. M. 

Tables will be reserved for reunions of alumni 
of Boston University, Johns Hopkins, Bowdoin, 
McGill and Harvard University Medical Schools. 


The Journal of the Maine Medical Association 


IU 6 


Afternoon Session 
2.00-5.00 P. M. 

Clinico-Pathological Conference 

Julius Gottlieb, M. D., 

Lewiston, Me., Chairman 

The Clinico-Pathological conference will consist 
of case presentations as indicated below, with dis- 
cussion opened by a physician or surgeon to whom 
the pathological diagnosis is unknown. Following 
discussions, the Pathologist will present the find- 
ings as seen at postmortem. 

The first three papers will include complete 
presentation of the case history and follow up 
studies at the respective hospitals. The last series, 
if time permits, will be presented in synopsis form 
together with the Pathological findings. General 
discussions will be limited to five minutes. 

1. A Case of Unexplained Temperature and 

Chills, 

Paul R. Chevalier, M. D., Lewiston, Me. 
Discussion : H. C. Knowlton, M. D., Bangor, Me. 
Pathological Findings: 

R. A. Beliveau, M. D., Lewiston, Me. 

2. A Case Suggestive of Central Nervous Sys- 

tem Disturbances, 

H. E. Thompson, M. D., Bangor, Me. 
Discussion: E. H. Drake, M. D„ Portland, Me. 
Pathological Findings: 

H. E. Thompson, M. D., Portland, Me. 

3. A Case Presenting Slight Jaundice, Fever 

and Gastro-Intestinal Disturbance, 

Elton R. Blaisdell, M. D., Portland, Me. 
Discussion : 

William V. Cox, M. D., Lewiston, Me. 
Pathological Findings: 

Mortimer Warren, M. D., Portland, Me. 

4. A Brief Synopsis of Case Histories with 

Unexpected Pathological Findings, 

Julius Gottlieb, M. D., Lewiston, Me. 

A. Headache, Chills, Dyspnea, Cyanosis, Rapid 

Pulse. 

B. Sudden Death Following a Minor Injury. 

C. Disassociated Symptomatology with Appre- 

hension. 

Discussion: T. E. Hardy, M. D., Waterville, Me. 

Note: Summation of each case by Reginald 
Fitz, M. D„ Boston, Mass., Professor of Medicine, 
Boston University Medical School. 


5.00 P. M. 

Election of President-elect. 


5.30 P. M. 

Second Meeting of the House of Delegates. 


Evening Session 
7.00-9.00 P. M. 

Dinner-Dancing. 

9.00 P. M. 

Speech Defects, 

James S. Greene, M. D., Invitation Speaker, 

New York City 

Ladies invited. 


TUESDAY, JUNE 27, 1939 
Morning Session 

9.30 A. M. -12.00 M. 

Conferences 

I 

MEDICAL EXAMINERS 

President Oscar F. Larson, M. D., Machias, Me. 
Secretary George L. Pratt, M. D., Farmington, Me. 
Annual Meeting Maine Medico-Legal Society. 

II 

NERVOUS AND MENTAL DISORDERS 

Forrest C. Tyson, M. D., 

Augusta, Me., Chairman 

Symposium on Psychoanalysis 
Psychoanalysis in Relation to the Psychoses, 

Forrest C. Tyson, M. D., Supt., 
Augusta State Hospital, Augusta, Me. 
Some Psychoanalytic Conceptions and Ther- 
apy of the Psychoneuroses, 

Isador H. Coriat, M. D., Boston, Mass. 
Papers to be followed by discussion. 

III 

MEDICAL 

Henry C. Knowlton, M. D„ 

Bangor, Me., Chairman 
Program to be announced. 

IV 

SURGICAL (By Invitation) 

Gordon Morrison, M. D., 

Boston, Mass., Chairman 

Symposium on Traumatic Surgery 

Assisted by 

Franklin Balch, Jr., M. D„ Boston, Mass. 
Sidney Wiggin, M. D., Boston, Mass. 

V 

EAR, NOSE AND THROAT 

L. E. Pratt, M. D., 

Lewiston, Me., Chairman 

1. Treatment of Common Colds, 

Elmer H. Jackson, M. D., Augusta, Me. 

2. Laryngotracheo Bronchitis, 

Harry Butler, M. D., Bangor, Me. 

3. Tuberculosis of the Larynx, 

George O. Cummings, M. D., Portland, Me. 

4. Mastoiditis, Medical and Surgical Treat- 

ment, 

Warren E. Kerschner, M. D., Bath, Me. 

5. Carcinoma, Larynx, 

Frederick T. Hill, M. D., Waterville, Me. 

6. Lateral Sinus Thrombosis, 

William H. Chaffers, M. D., Lewiston, Me. 

VI 

GENITO-URINARY 

C. Harold Jameson, M. D., 

Rockland, Me., Chairman 

Urinary Stone 

VII 

X-RAY 

1. The Variation of Radiation, Intensity De- 

pending Upon the Type of Pathology, 

Camp C. Thomas, M. D., Lewiston, Me. 

2. Interesting Cases Shown by 

Doctors Thaxter, Goodrich, and others 

Luncheon 

12.30 P. M. 

Past Presidents’ and County Secretaries’ Lunch- 
eons. 


Volume Thirty , No. 6 


Program 


147 


Afternoon Session 
2.00-5.00 P. M. 

SCIENTIFIC 

1. Our Disordered Profession, 

Pres. Willard H. Bunker, M. D., Calais, Me. 

2. The Chemotherapy of Pneumonia, 

Francis G. Blake, M. D., New Haven, Conn., 
Professor of Medicine, Yale Medical School 
Discussion Opened ly 

Elton R. Blaisdell, M. D., Portland, Me. 

3. Treatment of Ordinary Injuries, 

John J. Moorhead, M. D„ New York City, 
Professor of Surgery — New York Post- 
Graduate Medical School 
Discussion Opened ly 

William V. Cox, M. D., Lewiston, Me. 

4. Rural Community Hospitals, 

John T. Morrison, M. D., New York City 
Discussion Opened ly 

Frederick T. Hill, M. D., Waterville, Me., 
and Frank D. Weymouth, M. D., Brewer, Me. 


Evening Session 
7.00 P. M. 

Annual dinner — (dress informal). 

Introduction of visiting delegates. 
Presentation of fifty-year medals by 

President Willard H. Bunker, M. D. 
Burton K. Murdock, Kennehunk, Me. 

Representing Maine Pharmaceutical Associa- 
tion. 

Banquet Guest Speaker, 

Morris Fishbein, M. D., Chicago, 111., Editor of 
The Journal of the American Medical 
Association, “American Medicine and the 
National Health Programme.” 


Note: Medical, Obstetrical, and Surgical Motion 
Pictures will be shown at various times through- 
out the session. 


GOLF TOURNAMENT 

Handicap golf tournament for members of the 
Maine Medical Association. Eighteen holes to be 
played either Monday or Tuesday. Kicker’s handi- 
cap. Three gross and three net prizes. 


TO THE LADIES 

All of the evening sessions have been made espe- 
cially attractive for the ladies. There will be din- 
ner dancing on Monday evening. Munday and 
Tuesday afternoons there will be bridge parties 
with suitable prizes. Automobiles will be provided 
for a number of sight-seeing trips. We also have 
some fine motion pictures for the women who do 
not play bridge. 


MEDICO-LEGAL SOCIETY 

Medical Examiners, and others interested, are 
urged to attend the Conference and Annual Meet- 
ing of the Medico-Legal Society on Tuesday, June 
27th, 9.30 A. M., at Poland Spring. 

Attorney General Burkett will be present, also 
Attorney Herbert E. Locke, Senator H. C. Marden, 
and Representative Peter Mills, who all helped 


very much in getting our bill through the Legis- 
lature. 

All of the County Attorneys will be invited. 

Among other things, we need to consider the 
situation which will arise in 1941, when the new 
law goes into effect. 

George L. Pratt, Secretary. 


GREETINGS TO THE MAINE 
MEDICAL ASSOCIATION 

“The Maine Pharmaceutical Association extends 
to the Maine Medical Association its best wishes 
for a happy and successful convention. Grateful 
to you and your Ambassador, Dr. Adam P. Leigh- 
ton, in bringing about a closer affiliation of the 
two professions and earnestly willing to cooperate 
at all times for a clearer understanding between 
the two professions and for the benefit of the peo- 
ple which we serve.” 

Carl C. Anderson, President, 
Maine Pharmaceutical Association. 


GREETINGS TO THE MAINE 
PHARMACEUTICAL 
ASSOCIATION 

The ideals, interests and activities of Pharmacy 
and Medicine are so closely allied and interwoven, 
that it is folly indeed to procrastinate further in 
bringing about that fraternization and more inti- 
mate association which two of the oldest profes- 
sions in history should enjoy. Never was the time 
more propitious. Each of us needs the other, and 
we should give immediate and special thought to 
the various details of interprofessional relations. 
These two time-honored organizations must join 
forces and work together with whole-hearted co- 
operation and coordination in effort to the end 
that our mutual problems may be more easily cir- 
cumvented. 

Scientifically educated and trained men. as are 
we, working along almost identical lines of en- 
deavor, must realize how important it is that we 
maintain our high and century-old standards of 
practice. We have too much in common to allow 
for the slightest misunderstanding. 

Medicine and pharmacy have undergone a curi- 
ous transition in the past three decades. The 
problems are many. Doctors have been thought- 
less in their dealings with the druggists. Ethics, 
perhaps, seems a lost art. The influx of foreign 
professional men has caused unfair competition. 
The spectre of Socialized Medicine looms ahead. 
Cult practice has increased tremendously. Rank 
commercialism in certain instances within the 
pharmaceutical profession has done irreparable 
harm to each of us. The time has come for us to 
sit down and sensibly contemplate what is best for 
the future of Medicine and Pharmacy. 

For many years I have advocated that we join 
hands with the druggist and allow for an inter- 
change of delegates at our Annual Meetings. 
President Bunker has designated me as Delegate 
to the Maine Pharmaceutical Association at their 
June meeting, and I am pleased indeed for this 
privilege. The Pharmaceutical Association will 
send a delegate to our meeting at Poland Spring. 
We shall greet him warmly and enjoy his presence. 

May 1- this be just the starting point for an in- 
creased friendly interest and a better understand- 
ing, each for the other. 

Adam P. Leighton, M. D. 


148 


The Journal of the Maine Medical Association 


Official Delegates to the Eighty -Seventh Annual Session of the 

Maine Medical Association , 1939 


State Societies 

New Hampshire: 

A. J. Provost, Manchester. 

Henry L. Stickney, Togus (Maine). 

Vermont : 

W. H. McBride, Island Pond. 
Massachusetts : 

Frank W. Snow, Newburyport. 
Charles F. Warren, Amesbnry. 

Connecticut : 

Clyde L. Deming, New Haven. 
Alfred C. Henderson, Stamford. 

Rhode Island: 

Daniel V. Troppoli, Providence. 

J. Murray Beardsley, Providence. 


County Medical Societies 

Androscoggin: 

D. F. D. Russell, Leeds. 

L. A. Sweatt, Strong. 

W. E. Webber, Lewiston. 

• 

Alternates : 

R. A. Goodwin, Lewiston. 

H. L. Gauvreau, Lewiston. 

B. Beliveau, Lewiston. 


Knox: 

Howard Apollonio, Camden. 

A. J. Fuller, Pemaquid. 

Alternates: 

Gilmore Soule, Rockland. 

John B. Curtis, Brownville Junction. 

Oxford : 

E. M. McCarthy, Rumford. 

Alternate: 

John A. Green, Rumford. 

Penobscot : 

L. J. Wright, Bangor. 

Henry C. Knowlton, Bangor. 

Forrest B. Ames, Bangor. 

H. C. Scribner, Bangor. 

Alternates: 

L. H. Smith, Winterport. 

C. H. Burgess, Bangor. 

H. D. McKay, Old Town. 

Asa Adams, Orono. 

Piscataquis : 

F. J. Pritham, Greenville Junction. 
Alternate: 

R. H. Marsh, Guilford. 

Sagadahoc: 

A. F. Williams, Togus. 


Aroostook: 

W. B. Gibson, Houlton. 

H. E. Small, Fort Fairfield. 

Alternates: 

Storer Boone, Presque Isle. 
Arthur Whitney, Houlton. 

Cumberland : 

L. A. Brown, Portland. 

W. D. Anderson, Portland. 
J. C. Oram, South Portland. 
F. A. Smith, Westbrook. 
Ralph A. Heifetz, Portland. 

D. H. Daniels, Portland. 


Franklin : 

C. C. Weymouth, Farmington. 
Hancock: 

M. A. Torrey, Ellsworth. 
Alternate: 

J. H. Crowe, Ellsworth. 
Kennebec : 

Samuel H. Kagan, Augusta. 
Charles E. Towne, Waterville. 
Chalmers G. Farrell, Gardiner. 
Howard F. Hill, Waterville. 

Alternate: 

Ivan E. McLaughlin, Gardiner. 


Somerset: 

W. H. Walters, Fairfield. 


Alternate: 

W. S. Milliken, Madison. 


Waldo: 

Foster C. Small, Belfast. 
Alternate: 

Carl H. Stevens, Belfast. 


Washington: 

John F. Hanson, Machias. 


Alternate: 

James Bates, Calais. 


York : 

S. A. Cobb, Sanford. 

C. W. Kinghorn, Kittery. 

Alternates: 

W. H. Kelley, Biddeford. 

J. H. MacDonald, Kennebunk. 


Maine Pharmaceutical Association 
Burton K. Murdock, Kennebunk 


Volume Thirty, No. 6 


Commercial Exhibits 


14 9 


Delegate to the American Medical 
Association 

William A. Ellingwood, Rockland. 


Delegates to State Societies 

Neiv Hampshire : 

George L. Pratt, Farmington. 

Massachusetts : 

Carl M. Robinson, Portland. 

Rhode Island: 

George R. Campbell, Augusta. 
Connecticut : 

Eugene E. O’Donnell, Portland. 

Vermont (1938): 

Foster C. Small, Belfast. 


Delegate to Maine Pharmaceutical 
Association 

Adam P. Leighton, Portland 


Convention Rates 

Poland Spring House 
Poland Spring , Maine 

The following Room Rates, which include all 
meals, will prevail : 

Single rooms without bath $6.00 per day 

Double rooms without bath, per per- 
son $6.00 per day 

Double room and single room with 
connecting bath, for 3 persons, 

per person $7.00 per day 

Two double rooms with connecting 

bath for 4 persons, per person .... $7.00 per day 
Double room with bath for 2 persons, 

per person $7.00 per day 

Single room with bath, per person ....$8.00 per day 

The charge for non-registered guests for meals 
will be as follows: 

Ereakfast $1.50 

Luncheon $2.00 

Dinner $2.50 

Golf green fees will be $1.00 per day. The tennis 
courts and Beach Club will be available without 
charge. 

The Hotel Orchestra will be available four hours 
each day for dancing. 

Poland Spring Water , both Natural and Carbon- 
ated. will be served at all times to the guests of 
the hotel. 

For reservations write the Poland Spring 

House, Poland Spring, Maine. 

Make your reservations early!! 


Commercial Exhibits at Eighty-Seventh Annual Session 


George C. Frye Co., Portland, Maine. 

It is the plan of the George C. Frye Co., to pre- 
sent a most complete assembly of the latest in 
diagnostic equipment, office furniture and physi- 
cians’ supplies. 

Our representatives, Claude Lamson, Sidney 
Cheney and Edward Jones will be present to greet 
their friends. 


M & R Dietetic Laboratories, Inc., Columbus, Ohio. 

“Similac, a completely reconstructed powdered 
milk for infants deprived of breast feeding, will be 
on display. Messrs. John J. Krancer and Arthur M. 
McCormick will gladly explain the value of the 
zero curd tension of Similac as it applies to both 
normal and special feeding cases.” 


The Thomas W. Reed Company, Boston, Massa- 
chusetts. 

The Thomas W. Reed Company of Boston, Mass., 
are pleased to announce that at the coming Maine 
Medical Convention, Mr. J. F. Walsh will be in 
charge of the display. 

The latest type of Short Wave Apparatus, Pedes- 
tal Operating Tables and Portable Operating 
Lights will be exhibited, in addition to many other 
items, particularly interesting to Physicians. 


Surgeons’ and Physicians’ Supply Co., 761 Boyl- 
ston Street, Boston, Massachusetts. 

‘‘The Surgeons’ and Physicians’ Supply Company 
exhibit will be in charge of our local representa- 
tive, Mr. C. H. Joy. 

We will exhibit as far as possible a line of new 
and interesting items as well as equipment that 
can not usually be shown by a salesman. We 
will have a Comprex short wave, X-Ray, lamps, 
etc., including the new Hyfrecator, which we 
recommend your seeing.” 

General Electric X-Ray Corporation, 624 Beacon 
Street, Boston, Massachusetts. 

General Electric X-Ray Corporation will show 
an Electrocardiograph, Model F-3 Portable X-Ray 
Machine, Model C Electrosurgical Machine, Diag- 
nostic View Box. 

Portable X-Ray machine, suitable for all types 
of portable radiography, as well as light office 
work. 

New modernized Electrocardiograph, simple, 
portable and durable. 

New type Diagnostic View Box, which improves 
diagnostic values of all X-Ray films. 

Newly designed Spark Gap Electrosurgical Unit 
for all types of electric surgery, including desicca- 
tion and electrocoagulation. 


150 


The Journal of the Maine Medical Association 


Elmer N. Blackwell, 207 Strand Building, Port- 
land, Maine, Surgical Appliance Exhibit. 

Outstanding as an exhibit each year, since 1926, 
is the display of Corrective and Surgical Appli- 
ances which Mr. Blackwell brings to the Medical 
Meeting. You will find every reliable body appli- 
ance and many special designs available for men, 
women and children, that fill a definite need in 
such cases as Ptosis, Sacro-Lumbar Strain, Hernia, 
Leg Conditions, Arch and Foot Weakness, and 
Abdominal abnormalities. Mr. Blackwell invites 
you to take the opportunity at this meeting to 
inspect his line and become acquainted with these 
physiological supports. Mr. Blackwell will be 
pleased to explain or help with any problem in- 
volving support and show what the profession is 
using on their cases. 

The Denver Chemical Mfg. Co., 163 Varick Street, 
New York City. 

“Antiphlogistine, now in its forty-sixth year, is 
employed by physicians in all parts of the world 
in the treatment of inflammatory and congestive 
conditions. Members are invited to visit the ex- 
hibit and take a package of Antiphlogistine. Gala- 
test, a new micro-reagent for the instantaneous 
detection of urine sugar, will he demonstrated. 
This product has made a profound impression 
wherever it has been introduced.” 

The P. J. Noyes Company, Pharmaceutical Chem- 
ists, Lancaster, New Hampshire. 

We are grateful for the opportunity of contribut- 
ing in a modest way towards the success of the 
meeting of the Maine Medical Society. 

Joe E. Brown, Representative. 

E. R. Squibb & Sons, 745 Fifth Avenue, New York 
City. 

Physicians attending the Maine Medical Asso- 
ciation convention are cordially invited to visit 
the Squibb Exhibit in Booth No. 9. 

The complete line of Squibb Vitamin, Glandular, 
Arsenical and Biological Products and Specialties, 
as well as a number of interesting new items will 
be featured. 

Well informed Squibb Representatives will be 
on hand to welcome you and to furnish any in- 
formation desired on the products displayed. 

Mead Johnson & Company, Evansville, Indiana. 

Mead Johnson & Company will exhibit their 
complete line of infant diet materials and repre- 
sentatives will be on hand to discuss with physi- 
cians the application of the products. 

John Wyeth & Brother, Inc., Philadelphia, Penn- 
sylvania. 

John Wyeth & Brother, Incorporated, of Phila- 
delphia will exhibit at Booth No. 10. Wyeth is best 
known for its pharmaceutical specialties such as: 
Silver Picrate, in powder and suppository form 


for the treatment of trichomonas vaginalis; 
Amphojel, Wyeth’s palatable alumina gel, for the 
safer control of hyperacidities and the treatment 
of peptic ulcer; Kaomagma, the absorbent for 
diarrhea and intestinal disturbances; and Mucara, 
processed karaya gum indicated in intestinal 
stasis. 

Lederle Laboratories, Inc., The Statler Building, 
Boston, Massachusetts. 

Lederle Laboratories, Inc., will have a display 
consisting of a full line of biologies featuring the 
32 types of antipneumococcic therapeutic serum 
now available and a line of pharmaceutical spe- 
cialties featuring our Vi Delta Emulsion. 

Tailby-Nason Company, Boston, Massachusetts. 

“Tailby-Nason Company of Boston will exhibit 
Nason’s Palatable Cod Liver Oil, made in the com- 
pany’s own plants in the Lofoten Islands of Nor- 
way, romantic Land of the Midnight Sun. 

Nason’s oil is prescribed and recommended by 
leading pediatricians from the Atlantic to the Pa- 
cific for its high vitamin potency and unusual 
palatability. 

In addition, this old established Pharmaceutical 
house will display several of the most recent de- 
velopments of its research and pharmacological 
laboratories.” 

J. B. Lippincott Company, Philadelphia, Penn- 
sylvania. 

The Coca-Cola Company, Atlanta, Georgia. 

“The Coca-Cola Company will ice and serve 
Coca-Cola complimentary to the delegates attend- 
ing the Annual Session.” 

The C. B. Fleet Company, Inc., Lynchburg, 
Virginia. 

Phospho-Soda (Fleet) is a highly concentrated 
and purified, aqueous solution of sodium phos- 
phates. It is non-toxic, rapid and mild in action 
without irritation of the gastric or intestinal mu- 
cosa. Indicated for hepatic dysfunction, and for 
its thorough eliminating and cleansing action on 
the upper and lower intestinal tract. 

The C. B. Fleet Co. thank the medical profes- 
sion for the broader usage being given to Phospho- 
Soda (Fleet). Its prompt, acceptable and con- 
trollable action makes it an exceptionally efficient 
laxative saline and cholagogue. 

Sharp & Dohme, Philadelphia, Pennsylvania, 
Striking New Sharp & Dohme Display. 

Sharp & Dohme will have their new modern 
display at space 4 this year, featuring their well- 
known Propadrine Hydrochloride Products and 
new “Lyovac” Bee Venom Solution for the treat- 
ment of arthritis. There will also be on display 
a group of pharmaceutical specialties and bio- 



Always DEPENDABLE PRODUCTS 

Pharmaceuticals . . . Tablets, Lozenges, 
Ampoules, Capsules, Ointments, etc. 
Guaranteed reliable potency. Our pro- 
ducts are laboratory controlled. 


PRESCRIBE or DISPENSE ZEMMER 

Write for catalog. 

Chemists to the Medical Profession. 

The ZEMMER COMPANY 

Oakland Station, PITTSBURGH, PA. 


MA-6-39 


Volume Thirty, No. 6 


Treasurer’s Report 


151 


logicals prepared by this house. Capable, well- 
informed representatives will be on hand to wel- 
come physicians and furnish information on Sharp 
& Dohme products. 


Picker X-Ray Corporation, 920 Beacon Street, Bos- 
ton, Massachusetts. 

To the Roentgen Profession the name of Picker- 
Waite has always been synonymous with progress. 
The first successful Shockproof X-Ray Apparatus 
ever built was of Waite invention. 

Production facilities plus the combined re- 
sources of the Picker-Waite Organization, with an 
electrical and mechanical engineering background 
of over fifty-nine years, have made it possible to 
produce X-Ray equipment at a modest cost. 

One of the most outstanding pieces of Picker- 
Waite equipment is the Picker-Waite Century (100 
Milliampers — 100 Kilovolts) which has been pre- 
sented to the medical profession as a truly mod- 
ern diagnostic X-Ray apparatus . . . introducing 
for the first time an entirely new principle of 
flexibility in radiographic-fluoroscopic X-Ray de- 
sign and development. 

Point for point and dollar for dollar, the Picker- 
Waite Century is easily the most outstanding 
value in diagnostic X-Ray equipment offered to a 
discriminating clientele. 

We are proud to exhibit this unit with many 
new and outstanding smaller accessory devices at 
the meeting of the Maine Medical Association. 

Bulletins and descriptive literature may be ob- 
tained at our booth. 


Petrolagar Laboratories, Inc., 8134 McCormick 
Boulevard, Chicago, Illinois. 

Physicians are cordially invited to visit the 
booth of Petrolagar Laboratories, Inc., where 
Messrs, Schneider and Tarplin will be in attend- 
ance. 

Petrolagar is liquid petrolatum 65 cc. emulsified 
with 0.4 Gm. agar in a menstruum to make 100 
cc., accepted by the Council on Pharmacy and 
Chemistry of the American Medical Association 
for the specialized treatment of constipation. 

Scientific drawings and literature on the sub- 
ject of constipation will be available in addition 
to samples of the five types of Petrolagar. 

Codman & Shurtleff, 66 Plympton Street, Boston, 
Massachusetts. 

Est. 1838. 

This corporation has catered to the needs of the 
profession for over 100 years. We specialize in 
rebuilding and sharpening instruments, carry a 
complete line of general medical and surgical sup- 
plies and equipment. Under our new policy, a 
representative will call on the profession at regular 
intervals. We shall be glad to cooperate with any 
surgeon in the manufacturing and designing of any 
instrument to suit his special form of technique. 
Our reputation your guarantee. 

Arlington Chemical Company. 

H. P. Hood & Sons, Charlestown, Massachusetts. 
H. G. Fischer & Company, Chicago, Illinois. 


MEMBERSHIP CARDS 

Members must present membership cards before registering at the annual session. 


Treasurer s Report 

Chester A. Jordan Members of American 

Harold C. Jordan Institute of Accountants 

JORDAN & JORDAN 
Accountants and Auditors 
Fidelity Building 
Portland, Maine 

May 31, 1939. 

Maine Medical Association and Journal, 

Portland, Maine. 

Gentlemen : 

We respectfully report that we have completed our audit of your 
accounting records for the fiscal year ended May 31, 1939, and have 
found the same complete and correct in all details of record. Statements 
annexed hereto are, in our opinion, properly drawn up to show the true 
financial position of the Association May 31, 1939, and the income and 
expense for the year under review. 

Respectfully submitted, 

Jordan & Jordan, 

Accountants ancl Auditors. 


152 


The Journal of the Maine Medical Association 


MAINE MEDICAL ASSOCIATION AND JOURNAL 


Balance Sheet, May 31, 1939 
ASSETS 

Cash in Banks $14,775.97 

Accounts Receivable — Sundry -. 252.50 

Dues Receivable — 1939 112.00 

Advertising Receivable — 1939 353.59 

Securities (Cost) (See Schedule Attached) 7,405.00 

Furnishings and Equipment 948.93 

Impounded Cash 1,754.14 

Deferred Expenses — Annual Meeting Expense 43.25 


Total Assets $25,645.38 


TRUST FUND INVESTMENTS 


Prince A. Morrow Fund: — 

12 Shares American Agricultural Chemical Co. (Cost) $348.00 

Savings Account No. 3905, Canal National Bank 430.84 

Savings Account No. 54236, Fidelity Trust Co., Impounded 72.82 

$ 851.66 

Thayer Library Fund: — 

Savings Account No. 3903, Canal National Bank $845.41 

Savings Account, No. 54631, Fidelity Trust Co., Impounded 404.44 

1,249.85 


Total Fund Investments 2,101.51 


Total Assets and Fund Investments $27,746.89 


LIABILITIES AND CAPITAL 

Deferred Income: — 

Exhibit Space — 1939 Exhibition $ 779.50 

Capital Account— May 31, 1939 24,865.88 


Total Liabilities and Capital 


Trust No. 1 — Prince A. Morrow Fund 
Unexpended Income .... 

Trust No. 2 — Thayer Library Fund ... 

Unexpended Income .... 


TRUST FUNDS 


$25,645.38 


$ 568.52 
283.14 


$1,229.72 

20.13 


$ 851.66 


1,249.85 


Total Trust Funds 


2,101.51 


Total Liabilities, Capital and Trust Funds 


$27,746.89 


Capital Account, One Yeae Ended May 31, 1939 

Balance— June 1, 1938 $25,563.58 

Deduct: — Expenses, Herbert E. Locke, Attorney, relative to legislative matters, 

paid with Capital Funds $1,034.92 

Loss — Fidelity Trust Co., Checking Account — Maine Medical Journal — 24.45 

Final Dividend received 1,059.37 


$24,504.21 

$ 24.00 

337.67 

361.67 


Balance — May 31, 1939 $24,865.88 


Statement of Revenue and Expense, One Yeae Ended May 31, 1939 

REVENUE 

Dues $5,744.00 

Income from Securities 326.50 

Interest Received 228,40 

Exhibit Space — 1938 Convention 664.50 

C. M. A. B. Advertising 2,156.11 

Local Advertising 1,193.55 

Subscription and Sales of Journals 17.20 


Total Revenue $10,330.26 


Add: — 1934-35-36 Dues Received 
Net Gain — One Year 


Volume Thirty, No. 6 


Treasurer's Report 


153 


EXPENSE 

Salaries: — 

Dr. Jackson, Editor $1,000.00 

Augusta Office — Dr. Carter, Secretary and Treasurer 1,000.00 

Assistant 113.00 

Portland Office — Mrs. Kennard, Assistant Secretary 1,500.00 

Assistants 12.50 

Traveling Expenses: — 

President’s 200.00 

Secretary’s 150.00 

Councilors’ 107.94 

Office Expenses: — 

Supplies, Stationery, etc 298.74 

Postage and Mailing Expense 262.50 

Telephone 129.57 

Auditing 56.50 

Miscellaneous 108.73 

Committees 68. S5 

Clinical Session 108.89 

A. M, A. Meeting 253.50 

Medical Advisory Committee 500.00 

Annual Meeting 866.57 

Printing 3,216.75 

Plates 38.55 


Total Expense 9,992.59 

Revenue in Excess of Expense — One Year $337.67 


Statement of Cash Receipts and Disbursements, One Year Ended May 31, 1939 


Cash in Banks June 1, 1938 $15,523.97 

RECEIPTS 

Received from Dues $5,712.00 

Income from Investments 554.90 

Exhibit Space Rentals 820.50 

Liquidating Dividends — Fidelity Trust Co 212.04 

Subscription and Sale of Journal 17.20 

Advertising 3,280.62 

— 10,597.26 


$26,121.23 



CONVENIENT OFFICE 
TREATMENT FOR 

TRICHOMONAS 
VAGINITIS 


I HIS simple treatment requires but 
two office visits, a week apart, for insuffla- 
tions and the nightly insertion of a Silver 
Picrate suppository for twelve nights. 

Complete remission of symptoms and re- 
moval of the trichomonad from the vaginal 
smear usually is effected following the Silver 
Picrate treatment for trichomonas vaginitis. 
Complete information on request 


SILVER 


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'WJyeth 


The Journal of the Maine Medical Association 


154 


DISBURSEMENTS 

Salaries $3,625.50 

Traveling Expenses 457.94 

Office Expenses 856.04 

Committees, Clinical Session and A. M. A. Meeting 431.24 

Annual Meeting — 1938 and 1939 909.82 

Medical Advisory Committee 500.00 

Printing and Plates 3,255.30 

New Equipment 274.50 

Herbert E. Locke, Atty. — re Legislative Matters 1,034.92 

11,345.26 


Cash in Banks — May 31, 1939 $14,775.97 


Canal National Bank — Checking Account $4,408.47 

Canal National Bank — Savings Account 1,706.87 

Maine Savings Bank 4,348.20 

Portland Savings Bank 4,312.43 

$14,775.97 


Securities — Bonds, May 31, 1939 

Cost Mai'ket 

$2,000 Commonwealth of Australia, Ext. Loan 30 Yr. 5’s, 1957 $1,960.00 $1,990.00 

700 Prudence Bond Corp. 1st Mtge. Coll. Series 6, 5J’s, 1936 (Defaulted) 700.00 273.00 

3,000 Portland Terminal Co. 1st Mtge. 5’s, 1961 3,045.00 2,977.50 

1,700 Mortbon Corp. of N. Y. Reg. Coll 1,700.00 

$400 June 1, 1941, A 5’s 392.00 

400 1946, B 5’s 296.00 

400 1951, C 5’s 216.00 

500 1956, D 5’s 315.00 

10 Shares V. T. Class A, $1— Par 28.75 


$7,405.00 $6,488.25 


„ of vitamin V 

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The Journal 

of the 

Maine Medical Association 


Dolume Thirty Portland, ITlaine, July, 1939 No. 7 


Our Disordered Profession * 


By W. H. Bunker, 

How unfortunate that in this land of 
plenty, with abundant resources — a land in 
which the allied sciences have approached the 
peak of perfection — that the peace and tran- 
quility which rightly belongs to us should be 
so overshadowed by so much unrest, greed, 
instability and disregard for human hap- 
piness. 

Unfortunately these undesirable qualities 
are not confined to any one group of people 
but are scattered here and there among all 
organizations and we do not appear to be 
exempt. 

Certainly we are living in an era that will 
go down in history as the age of Scientific 
Achievements. 

In our own profession, on all sides, we see 
evidence of skill which denotes the highest 
type of intelligence. 

Even in this modest assembly hall, a meet- 
ing place for the members of our State Asso- 
ciation, we are surrounded by men who, be- 
cause of their high degree of intelligence and 
technical training must be regarded as 
authorities in their own line of work. 

To many of these men go the undisputed 


M. I)., Calais, Maine 

honor of having been responsible for some 
particular achievement in their line of prac- 
tice, the details of which they are only too 
willing to convey to their brother members. 

This is only one example of the gracious 
spirit and generosity of many of the leaders 
of our profession. Most assuredly such men 
as Claudeus Galen, Koch, or Pasteur, if al- 
lowed to spend a few short hours on this 
hemisphere during our present generation, 
would be shocked and amazed at the wonder- 
ful scientific achievements accomplished by 
the Medical Profession and they would in- 
deed regard it as the Age of Miracles. 

Many pages could be written without 
repetition on the scientific advancement of 
medicine, but justice would not be done my 
subject without showing some consideration 
to the social side of our practice which, due 
to the exigencies of a busy life, appears. to be 
somewhat neglected. 

After serving three years on the Council 
of the Maine Medical Association, one year 
as President-Elect, and this year as your 
President, I am more than ever satisfied that 
our legal and social activities require far 


* President’s Address. Read at the 87th Annual Session of the Maine Medical Association, Poland 
Spring, Maine, June 27, 1939. 


156 


The Journal of the Maine Medical Association 


more consideration than lias been customary 
in the past and unless more wholehearted 
cooperation is manifested on the part of 
many of our members I hesitate to predict 
the final outcome of our organization, for 
certainly inactivity, lack of cooperation, pro- 
fessional greed and jealousy, will be impor- 
tant factors in deciding the destiny of our 
profession. 

Money alone will not buy legislation, 
neither will it purchase success or happiness. 

They can only be obtained by years of 
diligent labor and by working with our fellow 
members in friendly accord. 

You are all aware of the fact that we are 
living in a period that demands action. We 
cannot with self-complacency fold our hands 
and place our hopes in the future. 

As a Medical Organization we have been 
represented to the people bv the government 
as a body of men incompetent of rendering 
adequate medical service to the needy and 
indigent. 

Even our honesty and integrity have been 
questioned. We have been accused of mis- 
demeanor and obliged to face a tribunal 
which will render its verdict in due time. 

Our professional activities have been di- 
rected by politicians laboring under the guise 
of humanitarians who certainly have little 
knowledge of the first principles of medical 
need or medical ethics. 

In fact a very carefully prepared program 
has been offered us for adoption which, if 
accepted by us as outlined, or forced upon us 
by legislation, will certainly spell disaster to 
our clientele and practically demoralize our 
own profession. 

This fact must be granted by the members 
of our Association and yet, confronted by 
such a calamity, what are we as members of 
the Maine Medical Association, doing to 
prevent it ? 

In discussing the subject of “Government 
Controlled Medicine” I do not wish to infer 
that I am in any way prepared to offer a solu- 
tion for this situation but refer to it only as 
an example to strengthen my point relative to 
the importance of keen legislation and social 
activities during these unsettled times. 

Are we doing all in our power to solve the 
legislative affairs of our organization, or are 


we prone to place the entire responsibility 
upon the shoulders of a few who are willing 
to sacrifice an unlimited amount of time and 
money for the good of our society ? 

Are we willing to throw our whole-hearted 
support into the work of -rebuilding and re- 
modeling a program which will be in accord 
with the fair-minded people of our country, a 
result of which the indigent and needy may 
be adequately cared for by our medical pro- 
fession, thus allowing us to remove forever 
any thought of regimented medicine which is 
so distasteful to us all ? 

Are we willing to take an active part in 
our State and County Societies or would we 
prefer to remain at home because of incle- 
ment weather or a similar excuse? 

Do we subscribe to and read diligently our 
State Journal or would we choose to casu- 
ally glance at the headlines and offer un- 
favorable comments ? 

Do we support the officers of our State 
Association and stand behind them in their 
various decisions ? 

Are we willing to curb those unkind re- 
marks made at the opportune moment and 
strive to conduct ourselves in an ethical man- 
ner, thus avoiding those unpleasant and 
nerve-wracking experiences of the so-called 
malpractice cases so often inflicted on brother 
members of our profession and their families 
as well, while the offender gets little or no 
satisfaction, but, instead, many hours of 
remorse and deep regret. 

And last, but by no means least, do we live 
up to the “Code of Ethics” adopted by the 
American Medical Association and the recom- 
mendations of the Judicial Council of that 
Association rendered at their annual meet- 
ing in San Francisco in 1938, thereby setting 
an example for the younger members of our 
profession by which they may be directed in 
the proper channels, so that in years to come 
they may be better and wiser men because of 
their relations with us? 

The excellent scientific qualifications pre- 
viously referred to cannot build a State Medi- 
cal Society, neither can they carry us through 
a period such as we are now facing. 

Questions are continually arising that 
would try even the patience of Job himself. 

If there ever was a time in the history of 


Volume Thirty, No. 7 


Our Disordered Profession 


157 


our Society when all members should work 
in unison, it is now. 

New laws must be made and obeyed in 
order that we may even exist as an organized 
society, for this very day while many of us 
are serenely happy with our success as pro- 
fessional men, blessed with the security of a 
good home and a comfortable income, differ- 
ent agencies representing our Government in 
Washington are carefully and stealthily 
weaving a web about us in the form of the 
Wagner Act, so securely that unless we rise 
up as an organized body and fight for a true 
cause and the opportunity to practice honest 


and ethical medicine, free from the unsound 
recommendations of our dictators, we will 
most certainly be engulfed in a stream of 
chaos and be compelled to step down from 
the high position which we now hold and 
become servants of the public, laboring under 
the jurisdiction of the lawmakers of our 
country. 

We must not forget that ive are living in a 
scientific, pleasure-loving age, surrounded by 
selfishness, greed and aggressive ambition. 

We love this land of ours, but we should 
be ever mindful that the Clock of Eternity 
keeps excellent time. 


Social Aspects of Tuberculosis — The pre- 
vention of tuberculosis is not merely a public 
health problem but also a powerful social and 
economic factor which affects the economic 
structure of the entire nation. 

“At a time when all values have tumbled 
and numerous assets have to be classified as 
frozen, the health and productivity of the 
people remain the outstanding and most tan- 
gible resources of a nation and it would be 
the short-sighted policy of the pennv-wise 
and dollar-foolish to curtail preventive health 
measures for the sake of economy,’’ says Dr. 
Karl Fiscliel of Saranac Lake. 

The tuberculosis problem is closely linked 
with other momentous issues of the day, and 
the tuberculosis death rate of the future is, 
therefore, bound to be affected by the solu- 
tion of other problems, be it unemployment, 
inflation, commodity prices or disarmament. 
(From an essay awarded the Leon Bernard 
Memorial Prize for 1938 by the International 
Union Against Tuberculosis) Fisciiel, Karl, 
Bull, de l’Union contre Tuberc., 1939, 16. 

Metastases to the skin occur more often 
than has been supposed. In an autopsy series 
of 2,298 malignant tumors of various types, 
2.7 percent had metastases to the skin. Their 
importance lies in the fact that they are not 
uncommonly the first evidence of the exist- 
ence of malignancy and also of metastasis. 
Contrary to current belief, metastases to the 
skin do not always herald approaching death 
hut may precede the terminal event by 
months or even years. They are of limited 


value in prognosis since the behavior of the 
skin tumors does not necessarily indicate 
rate of growth of the primary tumor. — Olive 
Gates, The A?n. Jour, of Cancer , August, 
1937. 


“A major impediment to maternal health, 
and, consequently, to child health, is syphilis. 
Yet it is one of the most easily correctable 
factors involved. A blood test of every preg- 
nant woman — as soon as she knows she is 
pregnant — will reveal syphilis if it is present. 
Treatment begun early will mean that she 
can bear a healthy child. Five months’ treat- 
ment during pregnancy is better than five 
years’ treatment after the birth of the child. 

“Ro mother objects to a silver nitrate so- 
lution in her baby’s eyes. She knows it pro- 
tects it against blindness from gonorrhea. 
She would not object to a blood test for de- 
termining the presence of syphilis or to the 
treatment for syphilis if she understood its 
importance to her baby. And her own infec- 
tion might have been prevented if the State 
in which she lived had required a blood test 
before marriage.” 

“The major indirect cost of syphilitic 
blindness, is loss of earning power. Assum- 
ing that each blind person unable to support 
himself represents a loss of earning power 
of $1,000 a year, Dr. Rice estimates an an- 
nual loss of $43,000,000 for all blind. Loss 
of earnings from blindness caused by syphilis 
amounts to approximately 15 percent of the 
total.” 


158 


The Journal of the Maine Medical Association 


Congenital Hypertrophic Pyloric Stenosis 

By Eaton Shaw Lothkop, M. D., F. A. C. S. 


Hypertrophic pyloric stenosis in infants is 
considered by most authorities to be of con- 
genital origin, as it has been found in infants 
of the later prenatal months. One case is 
reported in a seven-months’ fetus. 

It is about seven times as common in male 
children as in females. It occurs in about 
one male child in every two hundred, usually 
occurring in breast-fed children. Some claim 
that it is due to recurrent spasm of the cir- 
cular muscle fibres of the pyloric ring and 
canal. It would seem rather incredible that 
there could develop such marked hyperplasia 
as a result of spasm, especially when we find 
this disease in very young infants and even 
before birth. 

The view of Gray & Pirie that the spasm 
is due to hyperadrenalism, associated with 
the irritation of a long prepuce — thus ex- 
plaining its frequency in boys, is not sup- 
ported by further investigation, for it has 
been found in Jewish children and there is 
never any evidence of hyperadrenalism. 

The clinical picture is uniform but strik- 
ing. The diagnosis rests on the spitting up 
of food, beginning shortly after birth and 
becoming progressively worse until after 3 or 
4 weeks the vomiting becomes projectile, the 
stools becoming less frequent and smaller, 
and in the fully developed case, the gastric 
peristalsis with its ball-like waves is. easily 
recognized. In advanced cases, the pyloric 
tumor can be felt when the stomach is empty. 
The five major signs are: (1) Failure to gain 
in the absence of fever or other infection, 
(2) persistent vomiting of the projectile type 
shortly after feeding, (3) visible gastric peri- 
stalsis moving from left to right, (4) scanty 
stools, (5) palpable tumor. 

The evidence in recent years has made it 
manifest that in an established case there is 
little or no hope of cure bv medical treatment. 
In the early stages when the diagnosis is in 
some doubt, careful attention to the diet and 
long treatment should certainly be tried, but 
when once the diagnosis is certain, an opera- 
tion should be performed before the con- 
dition is advanced. The results of operative 


treatment, if performed early, are so satis- 
factory and the after-progress so remarkably 
good, that there can be no hesitation in ad- 
vocating this form of treatment. 

Surgical treatment was first attempted in 
1898. Its evolution to the present time has 
been quite remarkable. The original surgical 
procedure was about, the same as used on an 
adult for pyloric stenosis. Some operations, 
suggested and tried in the treatment of this 
disease, have been pylorectomy, plastic opera- 
tion of the Mikulicz type, that is cutting the 
muscles longitudinally and attempting to 
suture them transversallv, and forcible dila- 
tation after gastrotomy, also posterior gastro- 
enterostomy. The mortality is hi ah in such 
extensive operation when performed on an 
infant already greatly weakened by its in- 
ability to retain food. 

Tn 1912, Rammstedt demonstrated a sim- 
pler operation. Hot only is the type of opera- 
tion important for success but also the pre- 
operative and post-operative care. One or 
two days may be required to put the child in 
the proper condition for operation. Every 
attempt should be made to overcome the ex- 
treme dehydration with accompanying aci- 
dosis. Rectal and subcutaneous salines with 
or without glucose should be administered at 
regular intervals also directly before opera- 
tion. A hot water bottle may be placed under 
the child during operation. 

The Rammstedt operation consists in in- 
cising longitudinally through the serosa and 
thickened muscles, dividing them down to the 
mucosa. A two-inch right upper para rectus 
incision is made relatively high so that in a 
small child this lies over the liver. A finger 
can be hooked below the liver and the thick- 
ened pylorus felt at once and easily with- 
drawn. The tumor is held between the thumb 
and index finger of the left hand. Beginning 
at the duodenal end, an incision is made over 
the entire extent of the tumor in its least 
vascular part and through the peritoneum 
and superficial part of the circular muscle 
only. The cut muscular edges are separated 
well up on to the stomach by a blunt instru- 


Volume Thirty, No. 7 


Congenital Hypertrophic Pyloric Stenosis 


15 9 


ment until the mncuous membrane bulges 
into and completely tills the incision. There 
is a certain amount of danger of perforation 
of the mucosa at the duodenal end for here 
the pylorus ends abruptly. In the event of 
perforation close the opening by purse string 
and suture omentum over it. Evisceration at 
operation adds to shock and care should be 
taken not to allow this. Drop the pylorus 
back into the abdomen. Idle liver falls back 
over the line of incision so that the abdominal 
wall can be easily and rapidly closed. 

The after treatment is very important for 
the child is likely to collapse owing to its de- 
hydrated condition. Subcutaneous saline 
should be administered periodically. Body 
heat must be maintained. The case should be 
turned over to a pediatrician immediately 
after operation. 

The most important consideration is that 
the feedings should be small in quantity. The 
gastro-enteritis which so frequently compli- 
cates convalescence, and which is very often 
the cause of death, is largely due to unwise 
administration of large quantities of food be- 
fore the alimentary canal has regained its 
normal tone. There is a novel explanation for 
the diarrhea which frequently complicates 
convalescence. Before operation it is said 
that diarrhea is due to the growth of the 
colon bacillus in the alkaline intestinal tract ; 
most of the acid gastric juice is lost by vom- 
iting, but the pancreatic juice continues to 
flow and to alkalinize the duodenum and up- 
per jejunum. After operation, however, when 
food is retained and passes through the in- 
testinal tract, fermentation of the carbohy- 
drates takes place and diarrhea naturally 
follows. 

All writers emphasize the importance of 
getting the child out of the hospital as 
promptly as possible, the brevity of the stay 
after surgery being one of the chief argu- 


ments in this type of therapy. The English 
writers are particularly emphatic on this 
point. Wallace and Wevill report six patients 
in their series who were discharged a few 
hours after operation. Butherford mentions 
a five- weeks-old child who was taken home 
3 hours after operation and kept out-of-doors 
after the second day. If early discharge is 
not feasible, he advocates the rather utopian 
scheme of relays of nurses delegated to hold 
the child in their arms and thus insure 
constant body warmth. 

The immediate results of operation will 
depend very largely upon the time at which 
it is undertaken. Among the poorer hospital 
classes, where treatment is often delayed, the 
results are less satisfactory, and although 
there is a steady improvement in this direc- 
tion, most general hospitals still show a mor- 
tality rate of 20 to 25%. Individual series 
have given much better results than this. In 
the Children’s Hospital and Infants’ Hos- 
pital of Boston, in a series of 425 cases from 
1915 to 1931, the total mortality rate was 
6.3%. 

In a series of 44 cases at the Maine Gen- 
eral and Children’s Hospitals from 1933 to 
the present time there is a mortality rate of 
6 . 8 %. 

The after history of these cases is of very 
considerable interest. Scldesinger has re- 
ported the end results of a series, and has 
laid stress upon the fact that children so 
treated attain to an almost abnormal fitness. 
They have never once looked back and their 
weight and height were considerably above 
the normal. 

References 

Larnson, Surg., Gynec., cf- Obst., Sept. 1933. 

Lanman & Mahoney, Surg., Gynec.. & Obst., Sept, 
1933. 

Ramano & McFetridge, Internal. Surg. Digest, 
March, 1938. 


The life expectancy for untreated cancer 
of the esophagus, in the median case, is 7 
months, for cancer of the stomach, 13, and 
for cancer of the rectum 14 months after the 
onset of the first symptom directly referable 
to the disease. 


The median life expectancy of all patients 
with treated cancer of the stomach in this 
series is 15 months. — Ira T. Nathanson 
and Claude E. Welch, The Am. Jour, of 
Cancer , November, 1937. 


i6o 


The Journal of the Maine Medical Association 


Sulfanilamide and Sulfapyridine in the Treatment of Pneumonia* 


A REPOET OF 36 CASES 


By Benjamin Zolov, M. D., Chief of Medical Service, Farrington Hospital, and 
Eugene Guralnick, M. D., Resident Physician, Farrington Hospital 


Review oe Literature 

During the past two years, a major portion 
of the medical literature has been devoted to 
the use of sulfanilamide in various diseases. 
For the past six months, the use of a related 
drug, sulfapyridine, has again stimulated in- 
terest in the field of chemotherapy in this 
country. The purpose of this paper is to 
describe the use of both of these drugs in the 
treatment of pneumonia. A brief review of 
the literature, will precede our own experi- 
ence with these drugs. 

Sulfanilamide has proved bacteriostatic 
against types I, II, III, and XI V pneumo- 
cocci in vitro and in laboratory animals, ac- 
cording to various authors. While the drug 
probably has been used widely for human 
pneumococcic pneumonia, the reports to date 
are meager. ITeintzelman, Hadley and Mel- 
lon used it in nine cases of types III, and 
obtained seven recoveries, whereas among ten 
controls there were only two recoveries. 
Millet reported one case of type III pneu- 
monia in which a crisis occurred after the 
use of sulfanilamide. Louis added six cases 
of pneumococcic pneumonia in which recov- 
ery occurred with sulfanilamide therapy. 

Price and Myers describe 115 cases of 
pneumococcic pneumonia treated with sul- 
fanilamide. An initial dose of 15 grains to 
20 pounds of body weight was given to all 
patients; those over 160 pounds received a 
maximum dose of 120 grains. This total 
dosage was then continued, being divided 
into six equal doses, given every four hours. 
An equal amount of sodium bicarbonate ac- 
companied each dose of sulfanilamide. 

The toxic manifestations in their series 
include cyanosis in almost every case, ano- 
rexia, and nausea, lassitude, headache, and 
drowsiness, morbilliform rash in two cases, 
seven cases of fever, and acute hemolytic 


anemia in six cases. They compared the 115 
cases treated with sulfanilamide with 40 
cases treated with Felton serum and 94 con- 
trols who received no specific therapy. 

The results were analyzed from the stand- 
point of the type of pneumococcus, average 
age of the patients, duration of the pneu- 
monia before treatment, extent of the con- 
solidation, blood culture, initial white cell 
count, duration after the onset of treatment, 
associated diseases and complications. The 
mortality rate was 15.7 per cent for the en- 
tire sulfanilamide group and 30.8 per cent 
for the controls. The death rate for 57 
patients with types I, II, V, VII, and VIII 
pneumonia treated with sulfanilamide was 
10.5 per cent, whereas it was 27.5 per cent 
for 40 patients with the same types treated 
with serum. Of 21 patients with pneumo- 
coccic bacteremia treated with sulfanilamide, 
seven died ; of 12 treated with serum, six 
died ; and of 15 controls, 13 died. The most 
important toxic manifestation was anemia. 
In 5.2 per cent of the patients treated with 
sulfanilamide a severe hemolytic anemia de- 
veloped and in an additional 18.2 per cent 
moderate secondary anemia developed. 

Sulfapyridine or Dagenan, its trade name, 
was first prepared by Dr. A. J. Ewins and 
Mr. M. A. Phillips in the chemical research 
laboratories of May & Baker, Ltd., at Dagen- 
ham, England. Its development was the cul- 
mination of a large number of experiments 
undertaken in an effort to find a drug that 
was effective against the pneumococcus and 
at the same time possessed a chemothera- 
peutic index sufficiently favorable to justify 
its clinical use. Whitby demonstrated that 
Dagenan had a specific action against the 
pneumococcus, and Evans and Gaisford de- 
termined its value in the treatment of lobar 
pneumonia in human beings. 


* Read before the Portland Medical Club, May 2, 1939. 


Volume Thirty, No. 7 


Sulfanilamide and Sulfapyridine in the Treatment of Pneumonia 


l6l 


Sulfapyridine is a white crystalline pow- 
der with a melting point of 190.5° F. Sul- 
fapyridine, as compared with sulfanilamide, 
is relatively insoluble in water. 

In a series of 200 cases of pneumonia, 
Evans and Gaisford administered sulfapyri- 
dine to approximately alternate patients ad- 
mitted to the hospital, the control group re- 
ceiving routine nonspecific treatment. The 
mortality rate in the 100 controlled cases was 
27 per cent, whereas in the 100 patients who 
received sulfapyridine, there were only eight 
deaths. It was noted that the temperature 
fell within 48 hours in 60 of the patients 
treated with sulfapyridine, while in the con- 
trol group this occurred in 34 of the patients. 
On the basis of case mortality rates, clinical 
courses, and temperature curves in the two 
groups, it was concluded that sulfapyridine 
exerted a definitely beneficial effect on the 
course of the disease. 

Dyke and Reid reported results obtained 
with sulfapyridine in the treatment of eight 
cases of lobar pneumonia. In this small series 
it was found that chemotherapy was followed 
by a rapid fall of the temperature and pulse- 
rate and by improvement in the clinical con- 
dition. In all cases in which the drug was 
administered in full and efficient dosage, it 
is stated that the subsequent course was un- 
eventful and rapid recovery ensued. 

Barnett, Hartmann, Perley, and Ruhoff 
treated 23 infants and children with this 
drug. This series included 14 cases of pneu- 
monia, three of which were complicated by 
empyema, and one of these was further com- 
plicated by purulent pericarditis ; four cases 
of bronchitis ; three cases of pneumococcic 
peritonitis ; one case of influenzal meningitis, 
and one case of subacute bacterial endocar- 
ditis (Streptococcus viridans). 

The results obtained with sulfapyridine in 
the cases of pneumonia were confirmatory of 
those previously cited. A dramatic fall in 
temperature occurred in every case of pneu- 
monia within 28 hours of the institution of 
chemotherapy, and the decline in temperature 
was followed bv rapid improvement in the 
clinical condition of the patients. 

Wilson reports 70 cases of pneumonia in 
children, half of whom were treated with sul- 
fapyridine. The administration of sulfapy- 
ridine apparently shortened the course of 


pneumonia by three to four days. By statisti- 
cal analysis it was demonstrated that the fall 
in temperature and the clinical recovery were 
significantly earlier in the sulfapyridine 
group than in the control group. Wilson also 
found that a dosage which secures a level of 
free sulfapyridine in the blood of approxi- 
mately four milligrams per hundred cubic 
centimeters is therapeutically adequate. 

Barnett reports two cases of pneumonia 
complicated by empyema which showed no 
improvement by the drug. Despite the fall 
in temperature and the general improvement 
of the patients, fluid continued to collect in 
the pleural cavity and cultures from it re- 
mained positive. Resections of ribs with open 
drainage of the empyema were done in both 
cases, and the patients made uneventful 
recoveries. 

When sulfapyridine is administered orally, 
it is absorbed fairly rapidly from the gastro- 
intestinal tract, although not in such constant 
amounts as is sulfanilamide. Within a short 
time after administration, sulfapyridine may 
be detected in the blood by means of a test in 
which it is transformed into a colored dye 
substance. This is then compared with known 
standards prepared from pure sulfapyridine. 

Long and Feinstone report that the drug is 
found in purulent pleural exudates and in the 
spinal fluid in concentrations of from one- 
half to two-thirds of these observed in blood. 
Infection, or some factor accompanying in- 
fection, may alter the amount appearing in 
certain body fluids or exudates. 

AYitli average effective therapeutic doses, 
the blood levels of free sulfapyridine usually 
range from three to six milligrams per 100 
cubic centimeters. In adults the blood level 
occasionally may rise to ten milligrams or 
more per 100 cubic centimeters for appreci- 
able periods. Barnett et al. report that these 
higher blood levels are more commonly ob- 
served in infants and children. It is not 
known as yet why the percentage acetylated 
varies so widely in different individuals. In 
general, blood levels of free sulfapyridine are 
lower than those obtained with similar doses 
of sulfanilamide. 

Both the free and acetylated forms of sul- 
fapyridine are apparently excreted almost 
entirely through the kidney, but excretion 
does not proceed so rapidly as with sulfanila- 


162 


The Journal of the Maine Medical Association 


mide and may be retarded in the presence of 
renal impairment. Stokinger has reported 
complete excretation of free snlfapyridine 
within 24 hours following* the administration 
of a single dose, whereas Long and Feinstone 
have found that excretion may continue for 
three or four days after a single dose. Bar- 
nett, et al. report that following cessation of 
chemotherapy the drug remained in exudates 
in appreciable quantities for several days, 
while at this time only traces were found in 
the blood. 

Method of Study 

The Farrington Hospital is maintained by 
the City of Portland, Maine, for treatment of 
indigent cases. Approximately 175 patients 
can be accommodated ; a large percentage of 
whom come from homes receiving city aid. 
During the four months, from January 1, to 
May 1, we treated 36 cases of pneumonia 
here. Of these, 12 were treated with sulfa- 
nilamide and 24 with snlfapyridine. 

Since we had decided to review our pneu- 
monia cases, the following laboratory pro- 
cedures were carried out in each case, as the 
minimum requirements : 

(1) Throat Culture, sputum typing and 
blood culture. 

(2) Red Blood Cell count, White Blood 
Cell count, and Hemoglobin Determi- 
nation. 

(3) X-Ray of Chest. 

(4) Blood Determination for Sulfanila- 
mide or Snlfapyridine levels. 

As our bacteriological facilities at the Far- 
rington Hospital were inadequate, our cul- 
ture work and pneumococcus typing were 
done by the laboratories of the Maine General 
and State Street Hospitals. We experienced 
a great deal of difficulty in obtaining pneumo- 
coccus typings from the throat cultures of 
children in our series of cases, a condition 
reported by many other workers. Our diag- 
noses were based upon definite physical find- 
ings confirmed by X-Ray in every case. 

Routine blood level determinations were 
carried out in our own laboratory, along with 
the usual hematological studies. Facilities 
for blood determinations were started too late 
to be used on children who received sulfanila- 


mide in this series. We feel that it is most 
important in employing this type therapy, 
that blood level determinations be carried 
out, since the procedure can be adequately 
carried out with ordinary laboratory equip- 
ment. 

Method of Treatment 

Our general routine of treatment was as 
follows : 

Children on entry were seen by one of us, 
and after a careful history was elicited from 
parents, the child was thoroughly examined. 
Throat cultures and routine blood work were 
carried out before therapy was started. This 
is very important when using snlfapyridine, 
as the sputum may become negative for typ- 
ing shortly after starting the drug. Chest 
X-Rays were taken as soon after entry as 
possible. As a large percentage of the chil- 
dren were markedly dehydrated and mal- 
nourished, clyses of 5% glucose in distilled 
water, or 5% glucose in normal saline, were 
given soon after entry. Those children who 
were found to show low red blood cell counts 
or who were extremely malnourished were 
given small transfusions of citrated blood. 

Evidence of respiratory distress or cya- 
nosis on entry was treated by placing the 
patient in an oxygen tent. Restlessness was 
combated by the use of repeated small doses 
of codein or elixir of phenobarbital. Syrup 
of hydriotic acid was given for cough. 

Until snlfapyridine became available, 
seven of the children were treated with sul- 
fanilamide. In general, for this group of 
children, whose ages ranged from ten months 
to four years, 5 grains (.32 grams) of sul- 
fanilamide were given every four hours, day 
and night, until an adequate clinical response 
was obtained. We determined our dosage by 
definite clinical improvement in the condition 
of the patient and later by blood level find- 
ings rather than by the age or weight. With 
this evidence of improvement, the adminis- 
tration of the drug was gradually reduced. 
Our total dosage, ranged from 2 grams to 10 
grams, averaging 6 grams for the seven cases. 
An equal amount of sodium bicarbonate was 
given in each case. 

The procedures used in children were also 
carried out in the five adults, with addition 


Volume Thirty, No. 7 


Sulfanilamide and Sulfapyridine in the Treatment of Pneumonia 


163 


of more available sputum typings. Also 
morphine was given for restlessness, and 
elixir of terpene livdrate with codein was 
given for cough. The usual initial dose of 
sulfanilamide was 2 grams, followed bv 1 
gram every four hours. Total dosage here 
ranged from 15 grams to 40 grams averaging- 
26 grams. Average sulfanilamide determi- 
nations in this group were found to be 7 
milligrams per 100 cubic centimeters of 
blood. 

The total number of cases treated with 
sulfapyridine was 24. Of these, 13 were 
children and 11 adults. Our general man- 
agement of these cases was the same as for 
those previously mentioned, except that sulfa- 
pyridine was given instead of sulfanilamide. 

I 11 this group the youngest child treated 
was two months of age, and the oldest was 
eight years. Best results were obtained with 
the following dosage : 

(1) Up to six months of age one-fourth 
gram of sulfapyridine was given ini- 
tially, followed by one-eighth gram 
every four hours. 

(2) From six months to one year, one- 
half gram of sulfapyridine was given 
as initial dose, followed by one-fourth 
gram every four hours. 

(3) Older children received 1 gram for 
the initial dose and one-half gram 
every four hours. 

These doses were maintained until there 
was definite evidence of resolution of the 
pneumonic process by physical examination. 
Initial fall in temperature was not considered 
sufficient reason for diminishing the dose. 
Another important factor in continuing the 
dosage was the determination of the sulfa- 
pyridine level in the blood. Our best results 
were obtained with an average of 7.9 milli- 
grams per 100 cubic centimeters of blood, 
maintained until physical signs showed defi- 
nite improvement. The smallest total dosage 
given was 5% grams, while the largest was 
21 grams, the entire group averaging 16 
grams. At this point it should be noted that 
certain individuals, although given large 
doses of the drug by mouth, failed to show 
the expected blood sulfapyridine level. AYe 
encountered this condition in a three-month- 
old infant and in a 38-vear-old male. Four 


of the children treated in the series presented 
signs and symptoms of pneumonia following 
whooping cough, of an average of one month’s 
duration. This latter group received 150 to 
300 milligrams of Cevitamic acid daily, dur- 
ing the acute phase of the disease, continuing 
until the “whooping episodes” had subsided. 

Among the ten adults treated, ages ranged 
from 38 years to 83 years. Here we used an 
initial dose of 2 grams of sulfapyridine, fol- 
lowed by 1 gram every four hours, day and 
night. The same criteria were adhered to in 
subsequent reduction of the drug, as has been 
mentioned above in its use with children. An 
average blood sulfapyridine level of 9.3 milli- 
grams per 100 cubic centimeters was main- 
tained in the adults. The total dosage ranged 
from 10 to 50 grams, with 33 grams as 
average for the group. 

Case History Abstracts 

Case 31. S. C. This 59-year-old, white, 
married, female, entered the hospital because 
of pains in the chest with chills and cough of 
five days’ duration. Since the onset of her 
chills she had been confined to bed. She had 
been treated at the dispensary for “bron- 
chitis". for the past five years. 

Examination on entry revealed an ex- 
tremely emaciated appearing elderly female, 
in obvious respiratory distress. On percus- 
sion of chest, there was definitely impaired 
resonance at the right base. Tactile fremitus 
was increased in this area, with breath sounds 
bronchial, and increased whispered and 
spoken voice sounds. Her abdomen was dis- 
tended and tender. 

AA4 thin 24 hours after entry, temperature 
rose to 104° (F) rectally, and patient be- 
came moribund, and markedly cyanotic. At 
this time she was placed in an oxygen tent, 
and administration of sulfapyridine started. 
Her white blood cell count was 19,800, red 
blood cell count 3,800,000, and hemoglobin 
63 per cent. The sputum was reported, pneu- 
mococcus type VIII. X-Ray of her chest re- 
vealed consolidation of the right lower lobe. 
Blood cultures were negative, while blood 
Hinton was reported positive. She was given 
1 gram of sulfapyridine as initial dose, with 
continued dosage of 1 gram every four hours. 
Twentv-four hours after administration of 


The Journal of Maine Medical Association 


1 64 


the drug, her temperature fell to normal, and 
at this time the blood sulfapyridine level was 
8.6 milligrams per 100 cubic centimeters. 
White blood cell count at this time fell to 
15,500. The drug was continued in the same 
doses day and night for five days until the 
patient had received 30 grams. For the last 
three days, a total of 4 grams was given in 
diminishing doses. In all she received 34 
grams. 

The blood sulfapvridine determination on 
the 3rd, 4th, 5th, and 6th days, were 7, 10, 
8, and 9.5 mg. per 100 cc., respectively. The 
white blood cell count dropped from 9,900 
on the 3rd day to 5,000 on the 5th day, re- 
turning to 9,000 on the 6th day. During the 
first week of illness abdominal distension be- 
came marked, and she was treated for this 
complication. There was moderate nausea 
and occasional vomiting throughout the treat- 
ment. On the 5th day after the start of sulfa- 
pyridine administration, the patient was Avell 
enough to be removed from the oxygen tent. 
Convalescence was uneventful and she was 
discharged from the hospital 14 days after 
entry. 

Case 8. F. B. This 19-year-old, white, 
housemaid, entered the hospital complaining 
of cough, chest pain, and hemoptysis of two 
days’ duration. Past history revealed that 
the patient had been troubled bv intermittent 
asthmatic attacks since childhood. Three 
weeks before entry the patient had been dis- 
charged from the Isolation Hospital where 
she had been treated for a month as a diph- 
theria carrier. Following discharge from the 
Isolation Hospital she was well until five 
days before entry when she started to be 
troubled by cough. The day before entry, 
her temperature was 104° (F). Twenty-four 
hours later she was admitted to the hospital. 

Physical examination revealed a malnour- 
ished, young, white female, in marked respir- 
atory distress. Physical signs indicated con- 
solidation at both bases, which was confirmed 
by X-Rav findings. Her abdomen was mod- 
erately distended; she appeared very irra- 
tional and drowsy. 

Sputum revealed no pneumococcus types 
1 to 32, on direct typing, while sputum cul- 
ture showed S. P. aureus, and Hemolytic 
streptococcus. Her temperature was 105° 


(F) rectally, white blood count 17,000, red 
blood count 3,800,000, hemoglobin 70%. 

The patient was in an oxygen tent for the 
first six days of her illness. On the second 
day she was started on sulfanilamide. 1 gram 
every four hours. Delirium was marked for 
the first three days. On the third day her 
white blood count was 21,850, red blood cell 
count 4,300,000, hemoglobin 70. Blood sul- 
fanilamide at this time was 5.2 mg. per 100 
cc. On the sixth day white blood cell count 
was 27,050, red blood cell count and hemo- 
globin showed no change. On the eighth day 
blood sulfanilamide was 5.7 mg. W. B. C. Avas 
14,650, R. B. C. 3,320,000. 

Temperature dropped to normal on the 
10th hospital day. Convalescence thereafter 
Avas uneventful and she Avas discharged 21 
days after entry. 

Case 13. J. F. A two-month-old, white, 
male infant, weighing 8% pounds was sent 
to the hospital because of cough for three 
Aveeks, with listlessness, refusal of feedings, 
and respiratory distress on day of entry. He 
had been exposed to whooping cough at home, 
and when admitted his cough Avas paroxysmal 
in type. 

Examination showed an extremely emaci- 
ated, cyanotic male infant, coughing, and 
breathing Avith labored respirations. His tem- 
perature Avas 100.4° (F), respiratory rate 
116. There were scattered patches of con- 
solidation throughout both sides of the chest 
revealed by physical signs, and confirmed by 
X-Ray. Abdominal distension Avas noted. 

The infant was immediately placed in an 
oxygen tent, and sulfapyridine started. One- 
quarter of a gram was given initially, re- 
peated in four hours, and then one-eighth 
gram every four hours after that. The day 
after entry, the infant’s temperature fell to 
99.8° rectally, and his condition appeared 
worse. One hundred cubic centimeters of 
citrated whole blood was given by vein and 
coramine % c.c. Avas given every four hours. 
On the third day condition was still very 
poor, his temperature was 103.2° rectally, 
respirations Avere 116. The child became ex- 
tremely cyanotic when taken from the tent 
for a few minutes. Coramine and sulfapyri- 
dine were continued, and as fluids Avere being 
taken poorly, elyses of 60 to 100 C.C. of 


Volume Thirty, No. 7 


Sulfanilamide and Sulfapyridine in the Treatment of Pneumonia 


165 


5% dextrose in distilled water alternating 
with normal saline were given every eight 
hours. 

Three-sixteenths of a grain of ephedrine 
sulfate was given every four hours. This 
regime was continued to the 5th day, when 
the patient’s condition showed improvement. 
The temperature had reached normal at the 
end of the 4th day. It should be noted that 
this patient received 150 mgs. of cevitamic 
acid daily for six days because of the ex- 
posure to whooping cough. One-fortv-eighth 
of a grain of codein was given every four 
hours for restlessness. 

Throat cultures from this patient revealed 
pneumococci, but typing could not be estab- 
lished. The blood culture showed no growth. 
Blood sulfapyridine after four days of ther- 
apy was 15.3 mgs. per 100 c.c., W. B. C. 
16,000, R. B. C. 3,610,000, hemoglobin 66%. 
As chest signs persisted, the sulfapyridine 
was continued and after six days was 9.5 
mgs. per 100 c.c., while W. B. C. was 26,500, 
and hemoglobin was 65%. He was well 
enough to be taken out of the oxygen tent at 
the end of the eighth day and codein was 
discontinued. Blood sulfapyridine was only 
4.5 mgs., W. B. C. 19,500, hemoglobin 63%. 
Chest signs were clearing, and at this time 
the night doses of sulfapyridine were discon- 
tinued, completely omitting the drug a day 
later. Convalescence from here on was un- 
eventful, although some cough persisted for 
another week. This infant received a total 
of eight and one-half grams of sulfapyridine, 
and was discharged well at the end of 30 
days. 

Case 28. -J . M. This 40-year-old, white, 
male, clerical worker entered the hospital 
with a history of having been treated for 
pneumonia six weeks previously. At that 
time he remained in bed for only one week, 
returning to work against his physician’s ad- 
vice and despite a persistent cough, and weak- 
ness. His strength was apparently failing, 
until three days before entry, at which time 
he was too weak to get out of bed. He com- 
plained of pains in the right chest, severe 
cough, and fever. His condition became 
worse during the next two days, and 011 the 
day of entry a physician was called and he 
was sent to this hospital. 


Examination revealed an emaciated, pale, 
white, male with a severe cough, raising thick 
white sputum, irrational and appearing 
markedly toxic. Chest examination disclosed 
dullness to flatness from the right mid chest 
to the base, with distant to absent voice and 
breath sounds at the right base posteriorly. 
The left lung was clear and resonant. X-Ray 
showed consolidation of the right middle and 
lower lobes with definite fluid at the right 
base. 

Sputum typing was reported as type IV 
pneumococcus. Temperature 100.4° rect.ally 
on entry, rising to 102° within 12 hours. 
The W. B. C. was 16,000, R. B. C. 4,000,000, 
and the hemoglobin 65%. 

He was immediately started on sulfapyri- 
dine, receiving 5 grams within the first 12 
hours. For the next six days he received six 
grams of sulfapyridine daily and on the 
seventh day he received 5 grams. The tem- 
perature fell to normal after two days of 
treatment and remained normal for the next 
four days. On the second day after entry a 
diagnostic thoracentesis was done, withdraw- 
ing 150 c.c. of foul swelling purulent fluid 
which contained chains of streptococci on 
smear. The following day a closed thora- 
cotomy was done, using a metal drainage 
tube. The report on the fluid cultured at this 
time revealed anaerobic streptococci. O 11 the 
fifth day the patient complained of abdomi- 
nal pain and showed marked distension. 
Within 48 hours he had developed a para- 
lytic ileus. This was treated with Wagen- 
stein suction for small bowel decompression, 
rectal tubes, hot packs, enemas, surgical 
pituitrin and physostigmine. 

During, treatment with sulfapyridine, the 
patient’s blood sulfapyridine level ranged 
from 10 to 13 mgs. On the eighth day the 
W. B. C. was 24,000, hemoglobin 65%, the 
temperature rose to 101° rectallv, and the 
sulfapyridine was discontinued. A trans- 
fusion of 300 c.c. of citrated whole blood was 
given, and sulfanilamide therapy was started 
the next day because of the streptococcic 
empyema. Due to his condition the sulfa- 
nilamide was given by vein, in saline, until 
the continuous suction was removed. During 
the next week the patient was given three 
more transfusions of citrated whole blood, 
and from the 8th to the 23rd day he received 


1 66 


The Journal of the Maine Medical Association 


74 grams of sulfanilamide. This was given 
in doses of 8 grams daily and gradually was 
reduced. On tlie 21st day his temperature 
reached normal. However, on the 23rd day 
despite the normal temperature his pulse rate 
was 120, and since it had been increasing 
daily for the past three days, it was decided 
to discontinue the sulfanilamide. This re- 
sulted in a gradual return to normal of the 
pulse rate. Blood sulfanilamide averaged 
9 1/2 mgs. per 100 c.c. 

The patient’s distension was relieved after 
seven days of treatment. The empyema of 
the chest had been treated by continuous 
tidal drainage of the chest space with nor- 
mal saline, through the thoracotomy tube. 
The empyema cavity gradually closed off and 
the tidal drainage was discontinued after 
18 days. 

Convalescence from here on was unevent- 
ful, and the patient was discharged on the 
45th hospital day. Checkup X-Rays revealed 
obliteration of the empyema cavity and the 
thoracotomy wound healed well. 

Case 1. S. R. This ten-month old female 
infant, entered the hospital with a history of 
cough and “running ears’' of two weeks’ du- 
ration. Three days before entry, the cough 
grew worse, the child was very listless, re- 
fused feedings, and started to vomit on the 
day of entry. 

Physical examination revealed a well de- 
veloped and well nourished child, who ap- 
peared very drowsy. Examination of the 
ears revealed an inflamed left drum ; the 
right drum was normal. Chest signs indi- 
cated consolidation at the left base, with 
medium moist rales throughout both bases. 
X-Ray confirmed these findings. 

Temperature was 104° (F) rectally, and 
W. B. C. was 29,350. Sulfanilamide was 
started 24 hours after entry, and 2% grains 
were given every four hours. Small clyses of 
normal saline were given every eight hours, 
when necessary, and the child was placed in 
an oxygen tent immediately. 

Two days after entry, an otolaryngologist 
saw the child and paracentesis of both ears 
was performed. The patient maintained a 
septic temperature, ranging from 101° (F) 
to 106° (F) rectally. 

Two small transfusions were given five 


days after entry when R. B. C. was 
2,970,000, \V. B. C. 41,800, and hemoglobin 
57%. The ears stopped draining within 48 
hours after the drums were incised. 

One week after entry she developed 
marked distension of the abdomen with 
edema of the lower extremities. Despite all 
supportive measures, her condition grew 
worse, generalized edema set in, and on the 
tenth day she expired. 

Case -3J/.. C. C. This 79-year-old, white, 
female, was admitted from the chronic ward 
of the Boothby Home. She had been an in- 
mate there for the past five years and had 
been under treatment for cardiac decompen- 
sation and asthma on several past occasions. 
For two days previous to entry she had been 
vomiting and listless, and on the day of entry 
had become semi-comatose with labored 
respirations. 

Examination revealed an elderly, white, 
female, in moderate respiratory distress. Her 
pulse was irregular and weak, temperature 
was 104° (F ) rectally. Chest examination 
revealed consolidation throughout the entire 
right side. Heart sounds were of fair quality 
with irregular rhythm, rate 120. 

She was started on digitalis. Three grains 
were given every four hours. Twenty-four 
hours after entry sulfa pyridine was given, 
two grams as the initial dose, followed by one 
«r am every four hours. She also received 1 
c.c. of coramine every four hours. 

Xo sputum could be obtained for typing, 
but a blood culture, taken during a chill, was 
negative. Blood counts on admission were, 
W. B. C. 30,700, R, B. C. 4,820.000, hemo- 
globin 75%. Twenty-four hours after sulfa- 
pyridine administration the blood level was 
11 msis. per 100 c.c. She received a total of 
nine grams of sulfapyridine before death. 

Two days after entry, her condition sud- 
denly grew worse and she expired. 

Complications and Toxic Manifestations 

As with sulfanilamide, the toxic effects of 
sulfapyridine are sufficient to require careful 
usage of the drug and close observation of 
the patient. 

Xausea with vomiting is the most constant 
and frequent side effect with sulfapyridine. 


Volume Thirty, No. 7 


Sulfanilamide and Sulfapyridine in the Treatment of Pneumonia 


167 


Ho serious constitutional effects have been 
reported as a result of this untoward reac- 
tion, aside from the obvious loss of fluids and 
salts. In the sulfanilamide treated cases the 
above symptoms were less marked. With both 
drugs severe toxic effects of utmost impor- 
tance include acute hemolytic anemia and 
neutropenia which may be severe enough to 
classify as agranulocytosis. Unless daily 
blood counts and hemoglobin estimation are 
made, these serious reactions may not be de- 
tected. Up to the present, withdrawal of the 
drug and institution of appropriate therapy, 
particularly blood transfusion, have resulted 
in recovery. Toxic hepatitis, hematuria, 
anuria, urinary calculi, drug rashes and drug 
fever have been observed. In our series, two 
of the children developed a macular rash fol- 
lowing administration of sulfapyridine. Sul- 
fapyridine should be discontinued immedi- 
ately upon the discovery of any severe 
reactions. Anemia and neutropenia are es- 
pecially significant when noted during the 
early stages of severe pneumococcic infec- 
tions. A large percentage of our cases ex- 
hibited marked leukopenias which we feel 
were due to the drug, since withdrawal re- 
sulted in a return to normal. 

Cyanosis attributed to the use of sulfa- 
pyridine has been noted in a number of cases. 
However, it is rarely so marked as with 
sulfanilamide, and has not necessitated with- 
drawal of the drug. In pneumonia, cyanosis 
is quite frequent as a result of the disease, 
and any increase due to the drug is difficult 
to assess. There is no established proof that 
cyanosis is due to the formation of snlfhemo- 
globin, but, as in the case of sulfanilamide, 
it is suggested that saline laxatives and sul- 
fur-containing foods be avoided during the 
administration of sulfapyridine. 

Central nervous system disturbances in- 
clude vertigo, headache, malaise, mental de- 
pression, and occasionally excitement severe 
enough to be classed as toxic psychosis has 
been observed in a few cases. 

Hot infrequently it has been observed that 
discontinuing the drug too soon after the 
clinical response has been obtained may re- 
sult in a recurrence of the infection. We 
noted recurrences in three instances. Cases 
19 and 20 among the children, and case 35 
among the adults. Subsequent daily maxi- 


mum dosages in these cases resulted in final 
recovery. 

Statistics 

Among the 36 cases in this series, we en- 
countered 16 cases of lobar pneumonia in the 
adult group, whereas among the children 
treated here, we found only five cases of 
lobar pneumonia, with 15 cases of broncho 
pneumonia. I11 the sulfapyridine group, the 
following type pneumococci were found: I, 
III, IV, VI, VIII, and XIX. Hemolytic 
streptococcus and non-hemolvtic streptococcus 
and B. influenza were reported in several 
cases. In both groups we encountered cases 
which conld not be typed under pneumo- 
coccus groupings, 1 to 32. 

Among the sulfanilamide treated cases we 
found that the average number of treatment 
days before temperature returned to normal 
was 5 days for the children and 11% f° r 
the adults. Whereas among the sulfapyridine 
treated cases, the average number of treat- 
ment days before temperature returned to 
normal was two days for children and 36 
hours for adults. In averaging the number 
of hospital days before discharge, the figures 
concerning children were not used, because 
several of them came from such poor home 
environment that they remained here a month 
or two after they were well. 

Those adults treated with sulfanilamide 
averaged 20 14 days in the hospital whereas 
the sulfapyridine group averaged 13 days. 
The entire series of 36 cases was free of any 
major complications with one exception. 
However, in the sulfanilamide group we 
noted three cases of acute otitis media which 
required parcentesis. Xo empyemas devel- 
oped in any of our cases, although one case 
entered the hospital six weeks after onset of 
pneumonia, with definite signs and symptoms 
of empyema. This case, J. M., is discussed 
above. 

In the sulfanilamide group, we had one 
mortality. This occurred in a ten-month-old 
female infant. One death also occurred in the 
sulfapyridine group, in a 79-year-old female, 
who entered the hospital moribund. These 
cases were also outlined above. The mor- 
tality for the sulfanilamide group in this 
series was 8.3%. The sulfapyridine group 
had a mortality of 4.2%. 


/6s 


The Journal of the Maine Medical Association 


Summary 


(1) Thirty-six cases of pneumonia treated 
at the Farrington Hospital, are re- 
viewed in this paper. Of these, twelve 
were treated with sulfanilamide, and 
twenty-four with sulfapyridine. 

(2) In this small group it was observed 
that the sulfanilamide treated cases 
required a longer period of hospitali- 
zation, and did not respond as well as 
the sulfapyridine treated cases. How- 
ever, we feel that in this small series 
the drug cannot be fully evaluated. 

(3) Sulfapyridine treated cases showed a 
dramatic fall in temperature, with 


clinical improvement, following ade- 
quate therapy with this drug. The 
excellent results obtained here war- 
rant further use of the drug in the 
treatment of pneumonia. No serum 
was used in these cases. 

(4) Outstanding toxic manifestations in 
both groups were cyanosis, nausea and 
vomiting, with two cases of drug rash 
observed in children in the sulfapy- 
ridine treated group. 

(5) One death is reported in each group. 
The mortality for the sulfanilamide 
group was 8.3%, and for the sulfa- 
pyridine group it was 4.2%. 


Sulfanilamide Cases 


Case 

No. 

Age 

Sex 

Total Amount 
Given 

Type Pneumonia 

Complications 

1. S.R. 

10 mos. 

F. 

6 grams 

Broncho Pneumonia 

Ottis media, bilateral; paralytic ileus. 
Expired 9 days after entry 

2. B. G. 

10 mos. 

F. 

6 grams 

Right lower lobe 

Otitis media, bilateral 

3. D. P. 

1 yr. 

F. 

8 grams 

Broncho Pneumonia 

None 

4. A. P. 

1 yr. 

M. 

2 grams 

Broncho Pneumonia 

None 

5. R. B. 

18 mos. 

M. 

5 grams 

Broncho Pneumonia 

None 

6. T. C. 

2 yrs. 

M. 

10 grams 

Left lower lobe 

Otitis media, bilateral 

7. P. M. 

4 yrs. 

F. 

5 grams 

Broncho Pneumonia 

None 

8. P. B. 

19 yrs. 

F. 

23 grams 

Left lower lobe 
Right lower lobe 

None 

9.*R. B. 

23 yrs. 

F. 

30 grams 

Right lower lobe 

None 

10. F. E. 

30 yrs. 

M. 

15 grams 

Lobar entire right lung 

None 

11. H. H. 

45 yrs. 

F. 

24 grams 

Left lower lobe 

None 

12. |A. B. 

65 yrs. 

M. 

40 grams 

Right mid-lohar 

None 


S ULFAPYE I DINE CASES CHILDREN 


Case 

No. 

Age 

Sex 

Total Amount 
Given 

Type Pneumonia 

Blood Sulfapyridine 
Average Level 

Complications 

13. J.F. 

2 mos. 

M. 

81 grams 

Broncho 

Pneumonia 

9.2 mgms. 


14. E. N. 

3 mos. 

F. 

51 grams 

Broncho 

Pneumonia 

2.8 mgms. 


15. P. C. 

31 mos. 

M. 

5i grams 

Broncho 

Pneumonia 

8.5 mgms. 


16. M.M. 

8 mos. 

F. 

171 grams 

Broncho 

Pneumonia 

4.2 mgms. 

Macular rash 

17. S. D. 

10 mos. 

F. 

151 grams 

Broncho 

Pneumonia 

11.1 mgms. 


18. D.P. 

14 mos. 

F. 

14 grams 

Broncho 

Pneumonia 

9. mgms. 


19. J.F. 

21 yrs. 

M. 

17 grams 

Lobar 
L. L. L. 

9.2 mgms. 


20. M. M. 

2| yrs. 

F. 

21 grams 

Broncho 

Pneumonia 

12.1 mgms. 


21. J. P. 

3 yrs. 

F. 

12 grams 

Broncho 

Pneumonia 

7.5 mgms. 


22. M.L. 

3 yrs. 

M. 

71 grams 

Lobar 
R. U. L. 

9.1 mgms. 


23. D. G. 

4 yrs. 

M. 

121 grams 

Broncho 

Pneumonia 

4.5 mgms. 


24. D. D. 

7 yrs. 

F. 

19 grams 

Lobar 
R. M. L. 

8. mgms. 


25. R.V. 

15 mos. 

M. 

18 grams 

Broncho 

Pneumonia 

8.5 mgms. 

Macular rash 


Volume Thirty, No. 7 


Sulfanilamide and Sulfapyridine in the Treatment of Pneumonia 


1 69 


S U LFA PYK I DIN E CASES AdULTS 


Case 

No. 

Age 

Sex 

Total Amount! 

(jj veu Type Pneumonia 

Blood Sulfapyridine 
Level 

Complications 

26. F. C. 

38 yrs. 

M. 

50 grams 

Lobar 
R. L. L. 

3.5 mgms. 


27. H. W. 

39 yrs. 

F. 

18 grams 

Lobar 
R. U. L. 

12.4 mgms. 


28. J.M. 

40 yrs. 

M. 

46 grams 

Empyema 
Rt. Base 

10.5 mgms. 

Paralytic ileus. 

29. M. M. 

38 yrs. 

F. 

33 grams 

Lobar 
R. L. L. 

3.2 mgms. 


30. M. S. 

57 yrs. 

M. 

10 grams 

Lobar 
R. U. L. 

13.3 mgms. 


31. S.C. 

59 yrs. 

F. 

34 grams 

Lobar 
R. L. L. 

7. mgms. 


32. M. C. 

71 yrs. 

F. 

48 grams 

Lobar 
R. L. L. 

15. mgms. 


33. W. F. 

72 yrs. 

M. 

16 grams 

Lobar 
L. U. L. 

6.3 mgms. 


34. C. C. 

79 yrs. 

F. 

9 grams 

Rt. Lung 

11. mgms. 

Expired 2 days 
after entry. 

35. M. L. 

83 yrs. 

F. 

33J grams 

Lobar 
R. L. L. 

8.1 mgms. 


36. O. M. 

41 yrs. 

M. 

34i grams 

Lobar 
R. L. L. 

12.4 mgms. 



* Received 80,000 units of type 18 antipneumococcic rabbit serum, 
f Received 90.000 units of type III antipneumococcic rabbit serum. 


Bibliography 

1. Barnett, H. L., Hartmann, A. F., Perley, A. M., 

and Ruhoff, M. B., Treatment of Pneumo- 
coccic Infections in Infants and Children 
with Sulfapyridine, J. A. M. A.. 112:518-527, 
Feb. 11, 1939. 

2. Case Records, Farrington Hospital, Jan.-May. 

1939. 

3. Dyke, S. C., and Reid, G. C. K., Treatment of 

Lobar Pneumonia with M. & B. 693, Lancet, 
2:1157-1160, Nov. 19, 1938. 

4. Evans, G. M„ and Gaisford, W. F., Treatment 

of Pneumonia with 2- (p-aminobenzene sul- 
fonamide) Pyridine, Lancet, 2:14-19, July 2, 
1938. 

5. Flippin, H. F., Lockwood, J. S., Pepper, D. S., 

and Schwartz, L., Treatment of Pneumococ- 
cic Pneumonia with Sulfapyridine; Progress 
Report on Observations in 100 Cases, J. A. 
M. A., 112:529-534, Feb. 11, 1939. 

6. Long, P. H., Sulfapyridine; Preliminary Re- 

port of Council on Pharmacy and Chemistry, 
J. A. M. A.. 112:538-539, Feb. 11, 1939. 

7. Long, P, H., and Feinstone, W. H„ Observa- 

tions Upon Absorption and Excretion of 
Sulfapyridine (2 sulfanilyl aminopyridine) , 
Proc. 80 c. Exper. Biol. <(• Med., 39:486-491, 
Dec., 1938. 


8. Marshall, E. K., Jr., Determination of Sulfa- 

nilamide in Blood and Urine, J. Biol. Chem., 
122:263-273. Dec., 1937. 

9. Price, A. E., Myers, G. B., Treatment of Pneu- 

mococcic Pneumonia with Sulfanilamide, 
-7. A. M. A.. 112:1021-1027, March 18, 1939. 

10. Southworth, H., Cooke, C., Hematuria Abdomi- 

nal Pain and Nitrogen, Retention Associated 
with Sulfapyridine, J. A. M. A., 112:1820- 
1821, May 6, 1939. 

11. Whitby, L. E. H., Chemotherapy of Pneumo- 

coccal and Other Infections with 2- (p-ami- 
nobenzene sulfonamide) Pyridine, Lancet. 
1:1210-1212, May 28, 1938. 

12. Whitby, L. E. H., Chemotherapy of Bacterial 

Infections, Lancet. 2:1095-1103, Nov. 12. 
1938. 

13. Wilson, A. T., Spreen, A. H., Sulfapyridine in 

Pneumonia, J. A. M. A.. 112:1435-1439, April 
15, 1939. 

Sulfapyridine (Dagenan) was supplied by 
Merck and Co., Inc., in the study of our first 
ten cases. 

We wish to thank Dr. T. Bramhall, Super- 
intendent and Surgeon-in-Chief of the Far- 
rington Hospital, for his fine cooperation in 
this study, and Miss Marjorie Jensen, R. A., 
laboratory technician, for her able assistance 
in the hematological work. 


170 


The Journal of the Maine Medical Association 


Case History 


Mr. C. C. Case No. 48918. Age 33. 
Patient admitted December 18, 1936, com- 
plaining of pain in stomach and diarrhea of 
one week’s duration. 

P. I. Patient perfectly well until one week 
ago at which time he was taken with a chill 
and diarrhea, chill not noted again. Diar- 
rhea persisted every one-half hour according 
to mother. Blood noted in stools at least 5 
or 6 times. Has had anorexia, no vomiting. 
L. M. D. was called four days ago for first 
time. Saw patient again yesterday and sent 
him to hospital. 

Past History: No T. B., no malignancy 
or diabetes. Usual exanthemata and enan- 
themata. No scarlet fever, smallpox or diph- 
theria. No operations, serious accidents or 
injuries. Patient is a moron. Has done no 
work except in connection with his father 
who is a stone mason. B. P. 140/90. Temp. 
101, pulse 126, res. 30. 

Physical Examination: On admission very 
well developed and well nourished white 
male in questionable acute distress. 

Head: No masses, no tenderness. 

Ears: No discharge, no tophi. 

Eyes: kScleri clear, pupils round and react 
to light and accommodation. 

Nose: No discharge. 

Mouth : Clean. 

Teeth : Fair repair with sordes. 

Tongue : Moderately reel and coated. 

Throat : Slightly injected. 

Neck: Not stiff. Trachea in mid-line, no 
tug. Thyroid not enlarged. 

Chest : Symmetrical, equal and good expan- 
sion. Resonant throughout, no rales or 
friction rubs. 

Heart: Not enlarged to percussion. Good 
rate, rhythm and force. No murmurs 
heard. 

Abdomen : Flat. Dullness in both flanks to 
percussion. Spastic throughout. Tender- 
ness throughout, more marked in right 
lower quadrant with rebound tenderness. 
Reflexes equal and active. No ankle klonus. 
No Babinski. 


White count on admission, 9,200. Neut. 
84%. Eosin 0%. Baso. 0%. Lymph 
12%. Mono. 2%. H. B. 72%. R. B. C. 
4,790,000. 

Urine Chemistry: Negative. 

Microscopic Examination: Few coarsely 

granular casts. R. B. C. 14 to 16 per H. 
P. F. W. B. C. 40 to 20 per H. P. F. 

X-ray Ahclomen: Plate of upper abdomen 
with patient in sitting position shows no 
evidence of gas under the diaphragm. The 
whole left side of the abdomen shows an 
area of increased density without any gas 
in the intestines except just below the right 
lobe of liver. 

Impression — no evidence of intestinal ob- 
struction from this film. 

X-ray Chest: Mottled areas of increased den- 
sity involving both lung fields, but par- 
ticularly the right with particular dullness 
just, above the right diaphragm. Impres- 
sion — Bronclio-pneumonia, bilateral, but 
mainly at the right base. 

Patient to O. R. Free fluid, straw colored, 
found in peritoneal cavity. Terminal ileum 
gangrenous for about 14 inches. Mesentery 
adjacent to bowel edematous, congested. Re- 
section of gangrenous portion of ileum was 
done. A lateral anastamosis was made be- 
tween cecum and ileum. Patient never fully 
recovered from operation and died next day. 

Pathological Report: Specimen measures 

25 cm. in length, x 2.5 cm. diameter. The 
serosa is markedly injected throughout, 
but particularly in lower third, and shows 
patchy areas of hemorrhage. On section 
the mucosa is also swollen, and injected, 
and appears necrotic ; it is covered with 
a greenish exudate. The adjacent mesen- 
tery is also swollen and injected. At the 
upper end there is a section of about 4.5 
cm. of normal appearing intestine. In 
some places the swelling of the mucosa 
markedly reduces the lumen, but never 
completely. 

Microscopic : The mucosa throughout the 

affected area has been almost completely 


Volume Thirty , No. 7 


Case History 


171 


destroyed and replaced by a thick fibrino- 
purnlent exudate ; in the bowel wall gener- 
ally there is an acute inflammatory reac- 
tion, showing congestion, edema, and 
interstitial hemorrhages, with few poly- 
morphonuclear cells, except in focal col- 
lections, where they approach abscess for- 
mation. A similar inflammatory reaction 
is seen in the adjoining mesentery. 

Diagnosis: Regional ileitis (acute form). 

Post Mortem Examination: Clinical Diag- 
nosis: Terminal ileitis. One week ago 

patient had a chill, with diarrhea every 
half hour. Had bloody stools; no nausea 
or vomiting. Day before death became 
distended, with flatness over left half of 
abdomen. Central Xervous System — mo- 
ronic individual. Respiratory system nega- 
tive. G. IT. — bladder frequency; no lym- 
phadenopathy ; no edema. Exploratory 
operation performed 12/19 for fluid in ab- 
domen. On operation last 12 inches of 
ileum were found to be dark and gang- 
renous, mesentery swollen. Resection of 
ileum done, with side to side anastamosis 
of ileum to ascending colon. Patient never 
reacted and died at 8.45 A. M. on 12/20. 

Description : Body is that of a well devel- 
oped and nourished male about 30 years 
of age, 174 cm. in length. Rigor mortis 
slight; livor mortis marked. Pupils equal, 
slightly injected. In skin of lower ab- 
domen, on right, parallel to umbilicus, is 
surgical scar 15.5 cm. in length. There is 
some ulceration along gum margins of 
month, particularly on lower jaw. In It. 
antecubital fossa are marks of several vena- 
punctures. Abdominal incision well ap- 
proximated, sutures still in place. In lower 
end of wound is rubber cigarette drain, 
which leads down into right pelvis. There 
is small amount of bloody fluid in ab- 
domen. Second rib is anterior, large, and 
prominent on both sides. 

Thyroid : Hot examined. 

Thymus: Hot found. 

Lymph nodes: Ho general glandular en- 

largement. 

Pleural Cavities: Free, no fluid or adhesions. 

Right Lung: 725 gins. Well distended, sur- 


face mottled; lower and middle lobes show 
nodular areas of deep congestion, are not, 
however, completely consolidated. Also 
marked edema. Upper lobe fairly dry, 
bronchi contain frothy hemorrhagic fluid. 

Left Lung: 450 gins. Similar in general ap- 
pearance to right. Lower lobe shows some 
scattered areas of deep congestion and 
edema. Upper lobe somewhat similar but 
less marked edema. 

Pericardial Cavity : Pericardium smooth, 

small amount of fluid. 

Heart: 325 gins. T. V. 12 cm. L\ V. 7 cm. 
R. W. 5 mm. R. C. 10 cm. M. V. 12 cm. 
A. V. 7 cm. L. W. 22 mm. L. C. 10 cm. 
Aorta smooth, valves normal, coronary 
openings normal. Heart muscle good char- 
acter. Considerable epicardial fat on right 
side. 

Abdominal Cavity : See intestines. 

Spleen: 325 gms. 14 x 10 x 3.5 cm. Has 
deep sulcus. On section is dusky red color, 
follicles evident, fairly juicy. 

Rt. Kidney: 210 gms. 11x7x3 cm. Simi- 
lar in appearance to left. 

Lt. Kidney: 230 gms. 12 x 7 x 3cm. On sec- 
tion substance is quite pale. Cortex some- 
what irregular, average diameter 7 mm. 
Markings very distinct. Capsule strips 
readily, leaving smooth surface with in- 
jected blood vessels. 

Adrenals: Hormal. 

Pancreas: Hormal. 

Liver: 2,300 gms. 28 x 20 x 10 cm. On sec- 
tion rather greasy, consistency somewhat 
decreased, markings rather indistinct. 
Brownish-gray color. 

Call Bladder: Hot distended, not obstructed, 
no stones. 

Intestines: Stomach and duodenal mem- 

brane normal, except that duodenum is 
somewhat injected. In R. L. Q. is lateral 
anastamosis between remaining ileum and 
cecum, which is still well approximated. 
Stump of ileum has been turned in. Mu- 
cous membrane of cecum and adjoining 
colon appears to be normal, but that of 
sigmoid, rectum, and transverse colon ap- 
pears to be edematous, somewhat thick- 
ened, and slightly hemorrhagic. Mucous 


172 


The Journal of the Maine Medical Association 


membrane of remainder of small intestine 
normal. As one approaches distal portion 
it is rather thin, brownish color. 

Bladder : Not distended. 

Genitalia : Normal male. 

Cranial Cavity: Not opened. 

A natom ical D i agnosis : 

1. Congestion and edema of lungs, pos- 
sible broncho-pneumonia. 

2. Acute splenic tumor. 

3. Parenchymatous degeneration liver. 

4. Cloudy swelling of kidneys. 

5. Free fluid in abdominal cavity; no per- 
foration or signs of septic peritonitis. 

6. Intestinal tract remaining after resec- 
tion shows no definite lesions, except 
for congestion and edema of sigmoid 
area. 

Cause of Death : Evidence of sepsis, and 
from history, post-operative shock. Tissue 
No. 1127/36 — Portion of ileum — Diag- 
nosis: “Regional ileitis (acute form).” 

Microscopic : 

Lungs : Patchy broncho-pneumonia, ap- 

parently originating around bronchioles 
and spreading into lung in interstitial 
tissues ; both lungs similar. 

Spleen: Endothelial hyperplasia, with 

many phagocytes and erythrocytes. 
Liver : Cloudy swelling of many of liver 
cells, with edema and congestion around 
central vein. 

Kidneys: Moderate cloudy swellings of 
tubules, and some chronic interstitial 
nephritis. 

Colon : Mucosa partially ulcerated, ne- 

crotic, and infiltrated with poy morphs 
and small hemorrhages. 

Heart : Some edema of muscle fibers. 

Summary : 

Bilateral broncho-pneumonia. 

Cloudy swelling of liver and kidneys. 
Endothelial hyperplasia of spleen. 
Congestion and ulceration of sigmoid 
colon. 

Post-operative shock (following resection 
of intestine because of terminal ileitis). 


COMMENT 

George A. Tibbetts, M. D. 

In commenting upon a case of regional 
ileitis, I believe that mention should be made 
in terminology, for this condition is often 
spoken of as Terminal Ileitis and since the 
pathological process may occur at other por- 
tions of the ileum it seems better to classify 
the condition as Regional Ileitis, while at the 
same time recognizing that the most frequent 
location of the disease is at the terminal 
ileum. 

Evidently Regional Ileitis is a rare con- 
dition to be diagnosed but there is no doubt 
but that it is more common than we have 
believed, for since it has been definitely 
recognized as a disease, more and more cases 
have been reported. In the past, no doubt, 
some of these cases have been thought to be 
due to Tuberculosis and at times extensive 
Carcinoma. 

When once recognized the findings at 
operation are very striking the lead pipe 
feel of the disease area plus the characteristic 
color formation at the junction of the in- 
testine and the mesentary. 

Although the above case was not diagnosed 
prior to operation as soon as the abdomen 
was opened and the bowel was delivered into 
the wound, the diagnosis was instantly ob- 
vious because of the characteristic findings. 

Idle greatest difficulty in these cases is 
apparently in arriving at a diagnosis before 
operation for a definite diagnosis would as- 
sist greatly in choosing the proper surgical 
procedure. 

This case illustrates, for here we were deal- 
ing with an extremely sick individual of the 
proper age for a Regional Ileitis, having been 
sick for over a week, suffering with more or 
less abdominal pain accompanied bv diarrhea 
with some blood which might be sufficient 
data to raise the question of a Regional 
Ileitis and if the X-ray had been at all sus- 
picious of obstruction, a definite diagnosis 
might have been made even so far as locat- 
ing the lesion at the terminal ileum. 

Clinical Typhoid Fever was naturally the 
first condition considered, being the diagnosis 
on admission as well as the provisional diag- 
nosis after admission. When it was found 
that typhoid was probably ruled out by tests 
Continued on page XII 


Volume Thirty, No. 7 


The President's Page 


173 


The President’s Page 


To the Members of the Maine Medical Association : 

As this page must be in by June loth, I cannot comment on the annual meeting 
other than to state that, owing to the good work of the Scientific Committee, it 
should be an excellent one. 

The past year has brought up a number of difficult problems which have been 
met successfully under the able leadership of President Bunker. 

There are still problems, however, which we shall have to meet. 

Probably the most critical situation that the medical profession of this Country 
has ever faced is produced by the proposed legislation in Washington, the Wagner 
Health Act. 

I recently listened to a magnificent address on this subject by the President of 
the American Medical Association, and after hearing the report of our delegate. 
Doctor Ellingwood, and the address of Doctor Fishbein at our banquet, we should 
all know more about it than we do now. 

This page proposes to comment on various phases of this situation from time 
to time, and I would earnestly recommend that we all inform ourselves as thoroughly 
as possible. 

I am looking forward with a great deal of pleasure to visiting the various 
county societies, to meeting old, and, I hope, new friends. 

I ask for the active interest and cooperation of all in the affairs of our 
Association. 

George L. Pratt, M.D., 

President, Maine Medical Association, 


174 The Journal of the Maine Medical Association 



George Loving Pratt , M. D. 


In our present chaotic world-wide political, 
social and economic unrest, it is indeed sig- 
nificant of true Americanism that the Maine 
Medical A ssociation has chosen as its presi- 
dent, Doctor George Loring Pratt of Farm- 
ington; a man symbolic of our institution, 
lovable, philosophical, judicial and consider- 
ate — attributes nurtured through years of 
service in his own community — needs no 
further introduction. 

Oldest son of Rev. J. Loring and Lucy 
Church Soule Pratt, he was born in the 
Town of Strong, June 17, 1877. He at- 
tended the public schools in Strong and 
Farmington and received his higher educa- 
tion at Bowdoin College, obtaining his A. B. 
Degree in 1001 and Medical Degree in 1904. 
While at Bowdoin he became a member of 
the Delta Upsilon Fraternity, captained the 
baseball nine, played football and assisted 
Dr. Whittier in the gymnasium and labora- 
tory. During the period of his internship at 
the Maine General Hospital, during the year 
1905, he joined the Maine Medical and 
American Medical Associations; after which 
he returned to Farmington where he has 
since resided and practiced. 

The year 1909 witnessed three important 
steps in the progress of this lover of human- 
ity. His marriage to Ethel M. Stein of 
Winthrop; membership in the newly-organ- 


ized Franklin County Medical Society, which 
he has served for twenty-seven years as Sec- 
retary, and as President one year; and his 
appointment as Medical Examiner of Frank- 
lin County, which position he still holds. 

He belonged to the National Guard and 
Medical Corps ; served in the Army during 
the World War as Captain of the Medical 
Corps, with the 26th Div., A. E. F., until 
March, 1919. 

Since the establishment of the Franklin 
County Memorial Hospital in 1929 he has 
tirelessly given his knowledge, energy, and 
ability by serving on its surgical staff; has 
served for two terms as Councilor for the 
Maine Medical Association; and has been 
Secretary of the Maine Medico-Legal Society 
since 1936. 

His favorite pastime is playing Contract 
Bridge at, the Masonic Club, of which he is a 
member. Here one is privileged to listen to 
his ready wit and philosophical outlook on 
life. 

Every ready to assist, never forward, ever 
helpful, never boastful ; it gives pride and 
satisfaction to the Members of the Franklin 
County Medical Association, that their first 
member to be chosen President of the Maine 
Medical Association should be Doctor George 
Loring Pratt. 


Charles W. Bell. 


Volume Thirty, No. 7 Thomas Albert Foster, 2nd 175 



Thomas Albert Foster 2nd, 
M. D. 


Our president-elect is Thomas A. Foster 
2nd, for history records that his grandfather, 
after whom he was named, was a leading- 
physician in these parts from 1859 to 1896 
and that lie seiwed as “recording secretary” 
of this Association from 1862 to 1864, as 
treasurer from 1864 to 1878, and as presi- 
dent in 1884-1885. lie had two sons, both of 
whom practiced in Portland, — doctors 
Barzillai B. and Charles W. Foster. The 
former also was our president in 1907-1908 
and was our “Tom's” father. 

As for the president-elect himself, he was 
born, graduated from the Portland High 
School, from Dartmouth College and from 
the Harvard Medical School, all in due 
course of time. There followed a two-years’ 
internship at the Hartford Hospital before 
serving with British Hospital Number 
Twenty-two in 1916 and with the American 
Ambulance Hospital at NVnilly, France, in 
1917. The next year was spent with the 
United States Medical Corps and then came 
the establishment of an office in Portland for 
the practice of Pediatrics. 

Ever since, Doctor Foster has been most 
active in the practice of his profession, hav- 
ing devoted much of his time to the care of 


children on the medical services of both the 
Children’s and Maine General Hospitals, of 
both of which services he now is the Chief. 

The Association is to be congratulated 
upon having once more displayed good judg- 
ment in the selection of a president-elect. 
This office and that of president are no 
sinecures ; on the contrary, they impose upon 
their incumbents a heavy responsibility in 
these days of social unrest, when Medicine is 
at the “Cross Roads,” as it were, and these 
men have the right to ask for and to expect 
the active, intelligent cooperation of every 
member of the Association in the solution of 
their difficult problems. Let us not as pri- 
vates in the ranks be found wanting. 

We extend cordial greetings and hearty 
congratulations to Doctor Foster. Moreover, 
we congratulate ourselves, for he, with “the 
social smile and sympathetic tear,” is abreast 
of the times in medical-sociology even as he 
is in medicine. A man of good character, 
sterling qualities, excellent disposition and 
some spirit on occasion. His motto seems to 
be “give every man thine ear but few thy 
voice.” Wot a bad motto for a president-elect. 

E. W. Cr. 


17 6 


The Journal of the Maine Medical Association 


Editorial 

The Wagner Health Bill 


Any bill of the magnitude of the one bear- 
ing the name of the Senator from X ew York, 
now before the Senate, seriously concerns not 
only the profession of medicine but every 
other profession, every other business and 
the people of this nation individually and 
collectively. Wliat a national health bill pro- 
poses, what it will accomplish and how, who 
will CONTROL it and what it will cost, 
should not be a matter of conjecture and 
doubt by the profession that will have to 
work under its provisions and the taxpaying- 
public that must provide the money to pay 
for it. An analysis of the importance and 
seriousness of this proposed program must be 
provided and made available to the public. 
It has been intimated in no uncertain terms, 
that the present system of medical care in the 
United States is inadequate ; that the system 
under which the health and welfare of the 
people is taken care of is wrong, despite the 
fact that it has given the people of this coun- 
try the lowest death rate and the longest span 
of life of any country in the world, and the 
only thing to do is to install a politically 
controlled medical service. 

Certain facts regarding such far-reaching 
legislation, as the proposed bill of Senator 
Wagner as it now appears, must come from 
the profession of medicine. To aid in this 
purpose a physicians’ committee, working in 
alliance with the National Committee to Up- 
hold Constitutional Government, has been 
formed. The men on that committee warrant 
our support and confidence. Many of them 
hold important official positions in our Na- 
tional and State Associations. The president- 
elect of the American Medical Association, 
Dr. Van Etten, is on the committee from the 
State of New York, and we note with pleas- 
ure the names of Roger I. Lee, Trustee of 
the American Medical Association, and 
Creighton Barker of New Haven. The com- 
petency and honesty of purpose of this com- 
mittee is beyond doubt or question ; most em- 
phatically the profession is not engaged in 


any political fight or argument, but it intends 
most properly to present to the public and to 
the entire profession the facts and the seri- 
ousness of the legislation proposed by Senator 
Wagner. We know what a politically con- 
trolled practice of medicine will mean ; the 
public doesn’t, but that information can and 
must be furnished. It is the duty of every 
single practitioner to become familiar with 
the dangers of centralized control of medical 
practice. It is also his duty to explain to his 
patients and friends the necessity of the prac- 
tice of medicine being controlled by those 
competent to have valid opinions. 

It is extremely well that the profession 
and the public recall the methods employed 
in obtaining the recent indictment against 
the American Medical Association. Certain 
officers and members of the Association were 
accused of infringing the anti-trust laws in a 
criminal manner. The Assistant Attorney- 
General of the United States released to the 
press, with resulting widespread publicity, 
statements implying the guilt of the Associ- 
ation. One of his assistants is reported to 
have made statements from public platforms 
that the Association and its officers were 
criminally guilty before the hearings were 
held by the Federal Grand Jury. Withdrawal 
of Income and Social Security tax exemption, 
on the grounds that the Association is not a 
non-profit scientific educational foundation, 
is threatened, hence it may be reasonably 
asked whether the present bill of Senator 
Wagner is not a natural sequence of the vast 
and far-reaching propaganda directed against 
the profession of medicine through the 
American Medical Association. It can hardly 
be said that a national emergency exists de- 
manding the passage of the Health Bill of 
Senator Wagner or, in fact, any health bill. 
If grants are to be made by the Federal Gov- 
ernment to aid in the care of the needy in 
any State, surely the fact that such need 
exists must and should be determined. Re- 
sistance to this proposed legislation is based 


Volume Thirty, No. 7 


Report of the Delegate to the A. M. A. 


177 


on tlic fact that its need has not been shown 
to exist; that the bill as drawn is vague and 
presents a “set-up” that beyond rebuttal in- 
curs Federal control, but it is a most en- 
couraging fact, as expressed in an Editorial 
in the Journal of the American Medical /l.s- 
sociation, June 10, 1939, that the sub-com- 
mittee of the United States Senate appeared 
greatly impressed with the data presented by 
the American Medical Association. 

“Not only can the national health and wel- 
fare problems be solved readily by the states 
without guidance from Washington, if the 


national economic policies are adapted for 
the purpose of creating regular jobs for regu- 
lar wages, but every other problem of human 
relations now agitating the bosoms of our 
zealous reformers in Washington, will like- 
wise be simplified. The problems of social 
security, taxation, labor-capital relations, de- 
fense against Isms’ and European ideologies 
will, under a program of industrial recovery, 
reduce themselves to simple, common sense 
American proportions.” Caul E. M’Combs, 
M. I). Journal of the Connecticut State 
Medical Society. Yol. three, number five. 


Report of the Delegate to the American Medical Association 


The ninetieth session of the A. M. A. was 
held in St. Louis, Mo., May 15-19, 1939. 
The headquarters was located in the Statler 
Hotel. 

The Standing Committees had arrived 
several days in advance ; reports had been 
made ready for presentation, and every detail 
which had to do with the 1939 session had 
been attended to. Time and place had been 
arranged, not only for the 16 divisions of 
medicine and surgery on the regular pro- 
gram, but for scientific demonstrations, mo- 
tion pictures and talks, also for subjects to be 
discussed in Scientific Assembly. 

The House of Delegates of the A. M. A. 
was called to order bv the Speaker, Dr. H. H. 
Shoulders of Nashville, Tenn., on Monday, 
May 15th, at 10.00 A. M. After the usual 
order of business and the Speaker had pre- 
sented his list of reference committees, the 
reports of the Standing Committees were 
read and referred to the proper committee 
for approval. 

Secretary W r est reported on May 1st the 
membership of the A. M. A. was 113,113 as 
compared with 105,406 in 1937 and 109,435 
in 1938. 

164 of the 177 Delegates were present at 
the opening session, including representatives 
from Canada, New Zealand and Australia. 

Several of the American Boards held 
examinations preceding the meeting. Doctors 
F. T. Hill and S. Judd Beach are on the 


board of examiners of the American Board of 
Laryngology and the American Board of 
Oph thalmol ogy respect i vel y . 

On Tuesday, May 16th, the third Sym- 
posium on Health in Education, under the 
sponsorship of the Joint Committee on Health 
Problems in Education of the National Edu- 
cation Association and the American Medical 
Association, together with the Section on 
Pediatrics, the Section on Preventive and In- 
dustrial Medicine and Public Health, the 
Section on Ophthalmology and the Section 
on Laryngology, Otology and Rhinology of 
the American Ale die a 1 Association was held 
with Dr. S. Judd Beach of Portland, Maine, 
presiding. 

SciENTllUC Exil IB ITS 

Fifteen sections of the Scientific Assembly 
sponsored section exhibits under the guid- 
ance of specially appointed exhibit represen- 
tatives, and an attempt was made to correlate 
the exhibits with the section programs. 

At the request of the Committee on Scien- 
tific Exhibit of the Board of Trustees there 
were two special exhibits this year. The Spe- 
cial Exhibit on Anesthesia occupied five 
spaces. Demonstrations were given, motion 
pictures were shown and pamphlets distrib- 
uted. The Special Exhibit on Fractures occu- 
pied six spaces with continuous demonstra- 
tions through the week. 

o 


178 


the Journal of the Maine Medical Association 


Diabetes 

Much interest was shown in the showing of 
the film “The Education of the Diabetic” in 
addition to which practical talks were given 
from 10.00 A. M. to 5.00 P. M. by Doctors 
Elliott P. Joslin, Endocrine Relations; H. F. 
Root, Diabetic Coma; Priscilla White, Preg- 
nancy and Diabetes; W. II. Olmsted, Ar- 
teriosclerosis and Diabetes; Richard Wag- 
ner, Juvenile Diabetes. Also questions and 
answers. 

There were 217 scientific exhibits which 
offered the same opportunities for post gradu- 
ate study as were given in the exhibit on 
I )iabetes. 

hi the general meeting 250 papers were 
read, 230 of which were supplemented bv 
lantern demonstrations or moving pictures. 

The Technical Exposition 

Almost an acre of space was occupied by 
the exhibit of 250 firms. Manning the ex- 
hibits were 1,200 representatives, men and 
women technically trained in their particular 
lines. Many of them scientists in their own 
right, some of them inventors, some of them 
doctors of medicine or science. 

Following a survey by The Commentator, 
the morning paper headlines the story of the 
meeting, “A World's Fair of the Medical 
Industry.” 

Summai’y Report 
Board of Trustees 

Within the last few years, many problems 
of the most important interest to medicine 
have demanded earnest consideration by 
medical organizations. Some of these prob- 
lems have been brought up more acutely be- 
cause of the activities of various agencies 
outside the medical profession that are most 
largely concerned with political considera- 
tions or because of long continued economic 
disturbances. The existing situation is one 
that has created tremendously larger demands 
than ever before on the time and effort of 
the officers, official bodies and administrative 
personnel of the A. M. A. Present indica- 
tions are strongly to the effect that even 
greater demands will be made on the Associ- 
ation in future years and it is reasonable to 


expect that further expansion of the Associ- 
ation’s facilities will be required. 

Business O per at i ons 

Gross income from all sources for the year 
ending December 31, 1938, amounted to 
$1,758,147.09. Total expense for the year 
amounted to $1,769,548.60, an increase of 
$136,481.68 over the total expenditures for 
the year 1937. The net loss for the year was 
$11,401.51. 

Payments received for Fellowship dues 
and subscriptions amounted to $655,875.91. 
Total receipts from the sale of advertising 
space amounted to $875,367.43. Income re- 
ceived from interest on investments was 
$86,857.26 and through the sale of securities 
the sum of $2,831.25 was realized. 

Auditor’s Report 

Litigation pending against the Association 
amounts to the sum of $4,750,000.00. 

Possible liability in respect to Federal So- 
cial Security Taxes amounting to $90,000.00 
is also pending. The Association has ap- 
pealed to the Bureau of Internal Revenue for 
reconsideration of a ruling made on April 28, 
1938, classifying the Association as a busi- 
ness league, to reclassify it as a scientific and 
ed ucat i onal organ ization . 

G roup Hospitalization 

Polio/ Established by House of Delegates 

In June 1937, the House of Delegates 
recommended that the contract benefit pro- 
vided by group hospitalization insurance 
should be limited to the room, bed, board and 
nursing facilities ordinarily provided by hos- 
pitals, and routine medicines. In regard to 
certain benefits offered by many hospifal in- 
surance plans, combining professional and 
technical services, your reference committee 
is in complete sympathy with those who 
would make every possible provision to pre- 
vent inclusion of any and all types of service 
involving medical care. 

At the session of the House of Delegates in 
San Francisco (1938) the following was 
recommended : 

If for any reason it is found desirable or 
necessary to include special medical services 


Volume Thirty , No. 7 


Report of the Delegate to the A. M. A. 


17 9 


such as anesthesia, radiology, pathology or 
medical provided by outpatient departments, 
these services may be included only on the 
condition that specified cash payments be 
made by the hospitalization organization di- 
rectly to the subscribers for the cost of such 
service. 

At this session (1938) the House of Dele- 
gates recommended that a joint study be 
made by the Council on Medical Education 
and Hospitals and the Bureau of Medical 
Economics to determine the existing relations 
between hospitals and the physician practic- 
ing therein. This study was to be undertaken 
with a view toward a clearer definition of the 
relationships in the departments of anes- 
thesia, radiology, pathology and physical 
therapy in order that ethical standards may 
be established for the practice of physicians 
in hospitals which would prevent the ex- 
ploitation of either the public, the hospitals 
or the physicians. 

At the last meeting of the House of Dele- 
gates, in San Francisco, a resolution was 
introduced declaring that the serving of mem- 
bers of the American Medical Association on 
the faculties of schools of chiropody is un- 
ethical. The cause of the introduction of the 
resolution was a statement made in the 
annual report of the Judicial Council for 
that year that “teaching in cultist schools 
and addressing cultist societies is even more 
reprehensible” than association with cultists 
in practice. The resolution was referred to 
the Judicial Council as a reference commit- 
tee and on its recommendation the resolution 
was laid on the table. Since that meeting the 
Council has investigated the matter further 
and is of the opinion that the practice of 
chiropody is not a cult practice as is os- 
teopathy, chiropractic or Christian science, 
which have bases of treatment not supported 
bv scientific or demonstrated knowledge but 
on which bases all diseases are treated. 
Chiropody is rather a practice ancillary — a 
handmaiden — to medical practice in a 
limited field considered not important enough 
for a doctor of medicine to attend and there- 
fore too often is neglected. General opinion 
seems to be that chiropody fairly well satis- 
fies a gap in medical care that the profession 
has failed to fill. There are several reputable 


medical colleges whose faculties teach this 
branch of the healing art to students who 
later become chiropodists and the Council 
can see no reason to declare such teaching by 
members of this organization to be unethical, 
provided the schools in which they teach are 
connected with approved schools of medicine 
and recognized standards of premedical edu- 
cation are required. 

Medical Fee Schedules 

The necessity for or the advisability of 
such schedules has never been considered by 
House ; and 

Whereas, It has been an unwritten rule, 
established by a long line of ethical practi- 
tioners, both past and present, to adapt 
charges for medical services to the ability of 
his patient to pay, untrammeled by fixed 
community schedules ; therefore be it 

B e solved. That this device, appearing with 
increasing frequency, be examined by an ap- 
propriate agency of the A. M. A. to the end 
that the Association may declare itself on 
certain controversial points, among which 
are : 

(a) The advisability of or necessity for 
fee schedules in the public interest. 

(b) Their ethical or unethical qualities. 

(c) Necessity for certain fixed principles 
to guide constituent units of the Association 
when and if it is deemed, in the public inter' 
est, necessary to adopt such a device, and 

(d) Whether such schedules, approved by 
the constituent units of the Association should 
or should not provide for elasticity so as to 
permit of adaption to wage levels, specialized 
medical services, variations based on differ- 
ential costs as between urban, semi-urban and 
rural practice. 

Summary Report 

Council on Pharmacy and Chemistry 

Important legislation enacted by Congress 
during the year 1938 included a bill regulat- 
ing the advertising of foods, drugs and cos- 
metics outside the package, over the radio 
and through newspapers, the act providing for 
more effective control over the supervision of 


180 


The Journal of the Maine Medical Association 


labeling and advertising accompanying pack- 
aged products and requiring the disclosure of 
the contents of the preparations. 

The law now recognizes and provides for 
pronouncements of expert medical opinion, 
and it is possible that the official opinions of 
the Council on Pharmacy and Chemistry 
may have some important influence in aiding 
in the formulating of decisions on the use of 
therapeutic agents. 

All provisions will become effective June 
25, 1939. 

Under the provision of a law enacted by 
the Seventy-Fifth Congress, osteopaths are 
given the same status as doctors of medicine 
under the United States Employees’ Com- 
pensation Act. 

The Committee on Medical Care recom- 
mended a special study of free service ren- 
dered by physicians and dentists throughout 
the United States. 496,000 records were pre- 
pared and distributed. 

As of February 28, 1939, 416 county 
medical societies in thirty-six states had com- 
pleted the study and returned to the Bureau 
of Medical Economics the Summary Sheets 
with information obtained. 

Medical societies in forty-five states and 
the District of Columbia are participating in 
the Study of Medical Care, and it is expected 
that an additional number of medical soci- 
eties will complete the Study at a later date. 

The Committee on Scientific Research 

Believes that its work should be continued 
and recommended that the same appropri- 
ation be made for 1939 as for 1938; namely, 
$12,500.00 for grants in aid of medical re- 
search and $1,200.00 for expenses of the 
committee. 

Council on Medical Education and, Hospitals 

Ray Lyman Wilber, Chairman, J. FT. 
Musser, Fred Moore, Reginald Fitz, Fred 
W. Rankin, Charles Gorden Heyd, Frank H. 
Lahey, William D. Cutter, Secretary. 

Owing to the pressure of extra work cre- 
ated by the National Health Conference last 
July and by the indictment of the Associ- 
ation by a grand jury of the District of 
Columbia, the Council was not in a position 
to make a complete report but an agreement 


has been reached with a representative group 
of radiologists as to a definition of the func- 
tion of the radiologist in the hospital as 
follows : 

r Fhe responsibility for all radiologic exami- 
nations must rest on the physician-roent- 
genologist who is head of the department. 
TIis findings and conclusions for all examina- 
tions should be placed in the patient’s chart. 
Nothing in this provision should preclude 
additional study and interpretations by quali- 
fied attending physicians on the staff. 

Essentials of Approved Residencies and 
Fellowships 

Approved residencies and fellowships are 
offered in thirty branches of medicine. 

Two new departments having created 
American Boards of Certification have been 
added to this list. The department of radi- 
ology and tin* department of anesthesiology. 

After January 1, 1942, an applicant for 
certification by the American Board of Radi- 
ology must have completed a period of study 
after the internship of at least three years in 
a recognized institution or radiologic depart- 
ment. The period of specialized training 
should include an active experience of not 
less than twenty-four months and graduate 
instruction in pathologic anatomy, radio 
ph ysics and radiobiology. Board certificates 
are offered in (1) the entire field of radi- 
ology, (2) roentgenology, (3) diagnostic 
roentgenology and (4) therapeutic radiology. 

Anesthesiology — After January 1, 1942, 
the requirements for certification by the 
American Board will be interpreted as three 
years of special training and three years of 
additional practice in anesthesiology. It is 
expected that each graduate student should 
administer a minimum of 500 anesthetics a 
year, of which 400 should be general surgical 
in type. 

All laboratories should be under the super- 
vision and direction of a physician licensed 
to practice medicine in the state. 

At the Congress on Medical Education and 
Lincensure, the registration this year was 
550, a larger attendance than at any time 
within the last ten years. 

Through the Social Security Act, the fed- 


Volume Thirty, No. 7 


Report of the Delegate to the A. M. A. 


181 


eral government lias made available several 
million dollars for the further training of 
physicians. A number of state societies have 
found it possible through the cooperation of 
the state department of health, to direct the 
expenditure of this money and to strengthen 
their own programs of postgraduate educa- 
tion. In other states the health department 
has inaugurated independent courses with re- 
sults not altogether satisfactory. The Council 
feel that the House of Delegates might veil 
bring to the attention of each of the constitu- 
ent societies of the Association the paramount 
importance of retaining control of this phase 
of professional education. 

Total registration, 7,412. 

2,534 in the Section of Medicine 
1,265 in the Section of Surgery 

9 registered from Maine 
107 registered from Massachusetts 
7 registered from Xew Hampshire 
29 registered from Connecticut 
4 registered from Vermont 
7 registered from Rhode Island 

163 

The proceedings of the St. Louis Session 
are printed in detail in the Journal of the 
A. M. A., May 27, 1939. It is my wish that 
every member read it, that they may appreci- 
ate the amount of time and work the officers 
and committees give to your organization. 
The report of the Committee on Medical 
Care, Dr. IV. F. Braash, of Rochester, Minn., 
Chairman, is of extreme importance at this 
time when every practicing physician is con- 
fronted with political and lay interests in the 
Health and Welfare of the Public. 


I think we are all cognizant of the fact 
that the Wagner Bill is not to be overlooked. 
At the special meeting of the House of Dele- 
gates held in Chicago, September, 1938, a 
special committee was appointed to meet with 
the presidents' interdepartmental committee 
in Washington. This conference was very 
unsatisfactory. Again at this session held in 
St. Louis the same committee was delegated 
to meet with a subcommittee of labor and 
education on May 25, 1939. and explain the 
Resolutions on Opposition to the Wagner 
Bill as approved by the House of Delegates 
of the American Medical Association. 

The A. M. A. is exceptionally fortunate in 
having had as its President, Dr. Irvin Abell 
of Louisville, Ky., and again it is fortunate 
in having Dr. Rock Sleyster of Wauwatosa, 
Wis., at this time who with the exceptionally 
fine and experienced committee under the 
chairmanship of Dr. E. H. Cary of Dallas, 
Tex., will save “organized medicine.” 

For further and more detailed information 
on the subject I now invite you to come to 
the annual banquet of the Maine Medical 
Association to be held on Tuesday evening, 
June 27, 1939, at the Poland Spring House, 
and listen to the guest speaker, Dr. Morris 
Fislibein of Chicago, Editor of the Journal 
of the A. 21. A. 

You all know how fast he must write, but 
you will never know how fast a man can talk 
until you have heard him, and when he talks 
he says plenty. 

Respectfully submitted, 

Wm. Eijlixgvood, M. D., 

Delegate to A. 21. A. 


In carcinoma of the ovary we have what I 
believe is the one exception to the time-hon- 
ored axiom “once inoperable, always inoper- 
able." Several patients explored and closed 
as hopeless have been treated palliatively by 
external irradiation, repeatedly tapped, and, 
one or two years later, reoperated and the 
bulk of the devitalized tumor removed with 
recovery for a period of years. — F eajntk H. 
Smith, M. D., The Am. Jour, of Roentgen- 
ology and Radium Therapy , June, 1938. 


The fact that pure Krukenberg tumors are 
always secondary to carcinoma elsewhere 
should make this tumor as important to the 
gastro-enterologist as to the gynecologist. 
The gastro-intestinal tract should be exam- 
ined at every operation for ovarian tumor. 
The primary growth is sometimes so small, 
however, that its presence cannot be deter- 
mined at operation, regardless of careful 
search. — Axgelexe Simecek, The Am. Jour, 
of Cancer , September, 1937. 


182 


The Journal of the Maine Medical Association 


Nominating Committee Report 


The Nominating Committee, composed of 
Drs. Forrest B. Ames, Chairman, J. C. 
Oram, S. H. Kagan, E. M. McCarty, H. L. 
Appollonio and R. Bliss, made the following 
report at the Second Meeting of the House of 
Delegates, June 26, 1939, at Poland Spring, 
Maine. 

STANDING COMMITTEES 
Scientific Committee 

Merrill F. S. Greene, Lewiston, Chairman. 
II. C. Scribner, Bangor. 

Mortimer Warren, Portland. 

C. C. Weymouth, Farmington. 

Committee on Medical Education and 
Hospitals 

Adam P. Leighton, Portland, Chairman. 
Thomas A. Foster, Portland. 

Medical Advisory Committee 

Carl M. Robinson, Portland, Chairman. 
Allan Woodcock, Bangor. 

George E. Young, Skowliegan. 

Willard H. Bunker, Calais. 

C. Harold Jameson, Rockland. 

Frank H. Jackson, Houlton. 

Forrest B. Ames, Bangor. 

The Secretary, ex-officio. 

Legislative Committee 

The President, ex-officio, Chairman. 

The President-elect, ex-officio. 

R. V. N. Bliss, Bluehill. 

Warren Steele, Lewiston. 

N. H. Nickerson, Greenville. 

Public Relations Committee 

Warren E. Kerskner, Bath, Chairman. 
Frederick T. Hill, Waterville. 

H. C. Knowlton, Bangor. 

C. W. Kinghorn, Kittery. 

W. A. Ellingwood, Rockland. 

Cancer Committee 

Forrest B. Ames, Bangor, Chairman. 
Magnus Ridlon, Bangor. 


E. H. Risley, Waterville. 

William Holt, Portland. 

B. Beliveau, Lewiston. 

Committee on Social Hygiene 

E. S. Merrill, Bangor, Chairman. 

B. B. Foster, Portland. 

C. B. Popplestone, Rockland. 

Publicity Committee 

Thomas A. Foster, Portland, Chairman. 
The Secretary, ex-officio. 

SPECIAL COMMITTEES 

Committee on Nursing Affairs 

B. L. Bryant, Bangor, Chairman. 

Stephen S. Brown, Portland. 

George A. Tibbetts, Portland. 

T UBERCULOSIS COMMITTEE 

George E. Young, Skowliegan, Chairman 
Lester Adams, Hebron. 

Walter Gumprecht, Bangor. 

Committee on Investigation of 
Collection Agencies 

E. W. Gehring, Portland. 

Advisory Committee on Syphilis 
Control 

B. B. Foster, Portland, Chairman. 

Carl E. Blaisdell, Bangor. 

A. H. M orrell, Augusta, 

Committee on Prevention and 
Amelioration of Deafness 

Har ry Butler, Bangor, Chairman. 

P. J. Mundie, Calais. 

George O. Cummings, Portland. 

W. A. Ellingwood, Rockland. 

Wm. H. Chaffers, Lewiston. 

Committee on Problems of Health 
Insurance and State Medicine 

Warren E. Kershner, Bath, Chairman. 
Frederick T. Hill, Waterville. 

Howard Apollonio, Camden. 


Volume Thirty, No. 7 


Report of the Special Committee 


183 


Committee on Graduate Education 

Frederick T. Hill, Waterville, Chairman. 
Julius Gottlieb, Lewiston. 

Frank IF Jackson, Houlton. 

Eugene E. Holt, Portland. 

L. IP. Smith, Winterport. 


Committee on Maternal and Child 
Welfare 

Roland B. Moore, Portland, Chairman. 
A. W. Fellows, Bangor. 

C. S. Bauman, Waterville. 

G. W. Twaddle, Lewiston. 


Delegate to A. M. A. 

William A. Ellingwood, Rockland (two 
years). 


Resolution 


At the 87th Annual Meeting of the Maine 
Medical Association held at Poland Spring, 
Maine, June 25th, 26th, and 27th, the House 
of Delegates in session June 26th, voted to 
accept the following resolution as presented 
by George Tv. Pratt, M. D., of Farmington, 
and approved by the Council. 

Resolved: That, in the opinion of the 

Maine Medical Association, The Wagner 


Health Act proposes a revolutionary change 
in the practice of medicine, which is not jus- 
tified by reliable evidence; that the cost of 
the proposed legislation would be tremendous 
and indefinite ; 

That it is impossible to amend the Act so 
as to make it workable ; that our Senators 
and Representatives in Washington be in- 
formed that the Maine Medical Association 
urges them to oppose the passage of the Act. 


Report of the Special Committee Appointed to Confer with 
Committees from the Maine Hospital Association and 
Maine Nurses 5 Association to Consider the Problem 
of Nursing Education in Maine 


To the Officers and Members of the Maine 
Medical Association : 

Your Special Committee appointed to con- 
fer with committees from the Maine Hos- 
pital Association and Maine Xurses’ Associ- 
ation regarding the problem of Xursing 
Education in Maine begs leave to submit the 
following report. 

The three committees met in conference 
and took the following action : 

It was voted that a subcommittee from 
these three committees study the relative cost 
of graduate and student nursing service in 
hospitals in Maine. As the result of a ques- 
tionnaire sent to every hospital in Maine, it 
was generally agreed that it is more economi- 
cal and satisfactory to both patient and hos- 
pital to use graduate nurses in hospitals of 


less than fifty beds, and to employ the train- 
ing school method augmented by graduate 
nurses for hospitals of more than fifty beds. 
It was universally agreed that the present 
standards of nursing education be maintained. 
Xo one expressed a desire to lower these 
standards. Only five hospitals replying to the 
questionnaire stated they had any difficulty 
in securing graduate nurses. 

It was also voted that a subcommittee 
study the present status of nursing education 
in Maine and recommend future policies. 
This subcommittee has as yet rendered no 
report. 

Respectfully submitted, 

Frederick T. Hill, 

Chairman. 


I8U 


The Journal of the Maine Medical Association 


County News and Notes 


Aroostook 

The annual June meeting of the Aroostook 
County Medical Society was held at the Northland 
Hotel, Houlton, on June 20th, with about thirty 
members in attendance. 

After a six o’clock banquet, served in the Silver 
Room, the business meeting was opened by Dr. 
Oscar Norell. Matters pertaining to post-graduate 
work were discussed and the election of officers 
was held. The following officers were elected for 
the coming year: 

President — W. V. Kirk, Eagle Lake. 

Vice-President — A. T. Whitney, Houlton. 

Secretary-Treasurer — T. G. Harvey, Mars Hill. 

Board of Censors — F. Gregory, H. C. Kimball 
and P. L. B. Ebbett. 

Delegates to the Maine Medical Association — 
A. B. Hagerthy and H. E. Small. 

Alternates — Storer Boone and Oscar Norell. 

The first speaker of the evening was Dr. T. G. 
Harvey of Mars Hill, who gave an interesting re- 
view of his recent post-graduate work in Boston 
at the Bingham Foundation and outlined the 
modus operandi of the clinic. He then spoke on 
infant feeding, bringing out many scientific and 
good points in favor of breast feeding. Particu- 
larly interesting were the figures of one of his 
Professors recently emigrated from Germany who 
believes that the continuation of a pregnancy is 
not contra-indicated in pulmonary tuberculosis. 
It was the Doctor’s opinion that the various com- 
mercial infant foods were not necessary except in 
rare cases; milk from mixed herds is best; fre- 
quency of feedings is dependent on the baby, and 
he summarized his speech and analyzed the in- 
gredients of the various infant foods. 

The guest speaker of the evening was Dr. 
Arthur Van Wart. He spoke on the subject of 
“Medical Economics.” He compared the private 
practice of years past with the numerous State, 
clinic and governmental encroachments of the 
present time. He gave the premise that the medi- 
cally indigent must be cared for and so analyzed 
and compared the two logical approaches of (1) 
“State Medicine” or (2) “Health Insurance.” At 
this point Dr. Van Wart interrupted his paper for 
a round table discussion and Dr. Frank H. Jackson 
in opening the same outlined the situation in the 
United States, and urged all physicians to ac- 
quaint themselves with the Wagner Health Act. 
Dr. Van Wart then reviewed the health systems 
of Germany, Belgium and Russia, and these were 
found to be unsatisfactory to both physician and 
patient. He then sketched the advantages and dis- 
advantages of health insurance. From his paper 
and the prolonged informal discussion following 
it was obvious that Dr. Van Wart had given con- 
siderable time and thought to the subject. 


Dr. Arthur T. Whitney then spoke briefly on the 
Farm Security Administration as pertaining to 
the medical group of Aroostook County and it was 
voted to adopt the offer as set forth some time 
previously. There was very little discussion until 
the Society has some active participation in the 
plan. 

It was then voted to hold the October meeting 
at Mars Hill, Maine. 

The meeting was adjourned at 11.15 P. M. 

Respectfully submitted, 

Arthur T. Whitney, 

Secretary. 


Cumberland 

Portland Medical Club 

The regular monthly meeting was held at the 
Columbia Hotel, Tuesday evening, May 2nd, at 8.15 
P. M. Twenty-nine members and one guest were 
present. 

Dr. 0. H. Cox was elected to membership. 

Resolutions on the death of Dr. E. S. Cummings 
were adopted by the Club. 

A committee consisting of Dr. E. A. Greco, Dr. 
,1. C. Oram and Dr. .1. F. Wellington was appointed 
to arrange for the Annual Outing in June. 

The paper of the evening was by Dr. Benjamin 
Zolov, who spoke on Sulfapyridine and Sulfanila- 
mide in the Treatment of Pneumonia. He gave a 
summary of 40 cases of pneumonia treated at the 
Farrington Hospital. The paper was discussed by 
Drs. E. R. Blaisdell, D. H. Daniels, E. A. Greco, 
C. B. Sylvester, R. S. Hawkes, T. C. Bramhall and 
F. A. Ferguson. 

Alice Whittier, Secretary. 


Knox 

A meeting of the Knox County Medical Associ- 
ation was held at the Copper Kettle, Rockland, 
Maine, June 8, 1939. The meeting was called to 
order by Dr. Apollonio, President. 

Notes of the last meeting were read and two 
applications for membership were discussed and 
referred to the censors. 

It was voted that the Secretary write to Mrs. 
Leijonborg of Liberty, expressing the sympathy 
of the Association in the death of Dr. Frans 
Leijonborg. 

Plans for the August meeting were discussed, 
and it was left to the President to select the place. 

Dr. Carswell reported on the adjustment of the 
Camden Hospital situation. 

Dr. Ellingwood reported the proceedings at the 
American Medical Association meeting at St, 


Volume Thirty, No. 7 


County News and Notes 


185 


Louis, and the interest shown by the large 
attendance of delegates. 

The possibility of a meeting of the Maine Medi- 
cal Association at Rockland was speculated on, 
and Dr. Ellingwood appointed to serve as a one- 
man committee. 

Mr. Henderson, who was to talk on “Old Age 
Assistance as Relating to the Medical Profession,” 
was unable to appear, but Dr. Lawrence of Boston 
spoke on “The Disturbances of the Menopause,” 
and everyone was vitally interested and discussed 
the subject thoroughly. Drs. Jameson, Soule, 
Brown, Greene, and Ellingwood brought up mat- 
ters of interest. 

The meeting was then adjourned. 

Respectfully submitted, 

A. J. Fuller, M. D., 

Secretary. 


Oxford 

The regular meeting of the Oxford County Med- 
ical Society was held at Bethel Inn, Bethel, Maine, 
Wednesday, May 24, 1939. 

One new member elected to membership and one 
reinstated. 

Movies on Eclampsia, from the Maine State 
Health Department, were presented by Dr. G. 
G. Defoe. 

A very interesting paper on Observations Con- 
cerning Heart Failure was given by Dr. Eugene H. 
Drake, Portland, Maine 

About twenty-five members attended a fine ban- 
quet at the Bethel Inn. 

J. S. Sturtevant, M. D., Secretary. 


Piscataquis 

A meeting of the Piscataquis County Medical 
Association was held at the Braeburn Hotel in 
Guilford on May 25th. 

It was voted that a meeting be held at Moose- 
head Lake some time this summer, to which the 
Somerset, Penobscot, Kennebec and Aroostook 
County Medical Societies should be invited. 

Allan Woodcock, M. D., of Bangor spoke most 
interestingly on Fractures of the Femur. He clearly 
explained the proper use of Russell Traction, also 
the use of Skelatol Traction. 

Respectfully submitted, 

Norman H. Nickerson, Secretary. 


Washington 

The May meeting of the Washington County 
Medical Society was held at Dr. J. C. Bates’ resi- 
dence, Quoddy area, Eastport, on May 25, 1939. 


The meeting was called to order by the Vice 
President, P. J. Mundie of Calais. Minutes of last 
meeting were approved as read. A short business 
session followed. 

The first paper on the program, entitled “Epigas- 
tric Surgery,” was given by Harrison L. Robinson, 
M. D., of Bangor. 

The second paper, “Physiotherapy,” was deliv- 
ered by Harold Pressey, M. D., of Bangor. 

A long discussion followed. Those taking part 
were: Doctors Miner, Hanson, Bates, and Larson. 

A Buffet Lunch followed the meeting. 

Those present were: Doctors Metcalf, Mundie, 
Bunker, Miner, Bates, Gilbert, Hanson, Bennet, 
Burritt, Cobb, Crane, Norris, Larson, Robinson, and 
Pressey. 

The Society wishes to thank Dr. Bates of the 
Quoddy Hospital and Mr. Harry Gilson, Director 
of the National Youth Administration at Quoddy, 
for the use of their buildings, and entertainment. 

Oscar F. Larson, M. D., Secretary. 


New Member 

Oxford 

Beryl M. Moore, M. D., Oxford. 


Removal Notices 

w. H. Kelley, M. D., announces his removal from 
Sanford, Maine, to 26 South Street, Biddeford, 
Maine. 

Carl M. Robinson, M. D., announces his removal 
from 181 State Street, Portland, Maine, to 31 Deer- 
ing Street, Portland, Maine. 


Coming Meeting 

Notice 

The Piscataquis County Medical Society invites 
the members of Somerset, Aroostook, Penobscot 
and Kennebec County Medical Societies to a joint 
meeting at the Squaw Mountain Inn, Greenville, 
Maine, Wednesday, July 19, 1939, to which the 
ladies are invited. 

Dinner at 1.00 P. M. (Daylight Saving Time). 

Allan Woodcock, M. D., Bangor, Maine, will 
conduct a panel discussion on “Fractures.” 

George L. Pratt, M. D., Farmington, Maine, our 
newly-elected President, will be present. 

A cordial invitation is extended to all members 
of the State Association. 

This has been an outstanding mid-summer meet- 
ing for several years and it is hoped that we will 
have a good attendance. 


18 6 


The Journal of the Maine Medical Association 


Necrologies 


Henry I. Durgin, M. D., 

1864-1939 

Dr. Durgin died at his home in Eliot, June 15, 
1939. Born at Freedom, Maine, April 21, 1864, he 
studied medicine for a time under Dr. J. E. 
Scruton of Union and then entered the University 
of Vermont, later attending the University of New 
York where he was graduated in 1889. He began 
his practice in Newfield, Maine, but shortly after- 
ward moved to Eliot where he has been located 
since. 

He was a member and past president of the 
York County Medical Society, a member of the 
Maine Medical Association and the American 
Medical Association. On June 8th he was pre- 
sented with the Maine Medical Association's gold 
medal in recognition of his fifty years’ faithful 
service. 

Dr. Durgin was very prominent in fraternal 
circles and was a member of the Congregational 
Church. 

He is survived by his widow, Mrs. Alta Knox 
Durgin, to whom he was married forty-eight years 
ago. 

The vacant place that he leaves in our midst 
will be filled by the memories of generous serv- 
ices, sacrifices, and achievements. He was highly 
respected and deeply loved by all who had the 
good fortune to meet him. 


Joseph J. Pelletier, M. D., 

1880-1939 

Dr. Pelletier, for thirty-eight years a practicing 
physician in Lewiston, died at his home, June 4, 
1939. 

Born at Berlin, New Hampshire, April 1, 1880, 
the son of Damas and Bridget Wheeler Pelletier, 
he received his preliminary education in the pub- 
lic schools of Lewiston and was graduated from 
Bowdoin Medical School in 1901. In 1905 he 
studied at Paris, London and Rome, and four 
years later at the University of Louvain, Belgium. 

Dr. Pelletier was a member of the Androscoggin 
County Medical Society, the Maine Medical Asso- 
ciation and the American Medical Association. 
He served four years as a member of the Lewis- 
ton School Board and had also served as city 
physician. 

He was a World War veteran, having enlisted 
in the United States Army in September, 1917, 
and assigned to active duty in January of the fol- 
lowing year with the rank of Captain. 

He is survived by his widow, Rose M. Fisher 
Pelletier, to whom he was married in 1901, and a 
son. Dr. Anthony D. Pelletier of Lewiston. 



( 


Voiume Thirty, No. 7 


Book Reviews 


187 


Notices 


American Board of Internal Medicine, Inc. 

Written examinations for certification by the 
American Board of Internal Medicine will be held 
in various sections of the United States on the 
third Monday in October and the third Monday in 
February. 

Formal application must be received by the 
Secretary before August 20, 1939, for the October 
16, 1939, examination, and on or before January 1st 
for the February 19, 1940, examination. 

Application forms may be obtained from Dr. 
William S. Middleton, Secretary-Treasurer, 1301 
University Avenue, Madison, Wisconsin, U. S. A. 


Tumor Clinics * 

Portland: Maine General Hospital — -Thursday, 

11.00 A. M.-12.00 M. Director, Mor- 
timer Warren, M. D. 

Lewiston: Central Maine General Hospital — 

Tuesday, 10.00 A. M.-12.00 M. Di- 
rector, E. V. Call, M. D. 

St. Mary's General Hospital — Wednes- 
day, 4.00 P. M. Director, R. A. Beli- 
veau, M. D. 

Waterville: Thayer Hospital — Thursday, 9.00- 

11.00 A. M. Director, Edward H. 
Risley, M. D. 

Sistei's’ Hospital — Thursday, 9.00- 

11.00 A. M. Director, Blynn O. 
Goodrich, M. D. 


Bangor: Eastern Maine General Hospital — 

Thursday, 11.00 A. M.-12.00 M. 
Director, Magnus F. Ridlon, M. D. 

* Approved by Maine Medical Association. 


State of Maine Board of Registration of 
Medicine 

Adam P. Leighton, M. D., Secretary 

Physicians licensed to practice medicine and sur- 
gery in Maine on March 15, 1939: 

Through Examination 

Helen W. Bane, M. D., Farmington, Maine. 

Sidney Robert Branson, M. D., Passaic, New 
Jersey. 

Ernest LaPierre Coffin, M. D., Bar Harbor, Maine. 

Frederick Collins Dennison, M. D., Lynn, Massa- 
chusetts. 

George Pierre Desjardins, M. D., Brunswick, 
Maine. 

Walter Louis Henry Hall, M. D., Orono, Maine. 

Lillian G. Moulton, M. D., Northboro, Massachu- 
setts. 

Alfred Oestrich, M. D., Rumford, Maine. 

Julius Sherman, M. D., Mattapan, Massachusetts. 

Frank Rocco Visceglia, M. D., Brooklyn, New 
York. 

Through Reciprocity 

Henry Almond, M. D., Rochester, New Hampshire. 

Nicholas Famularo, M. D., Queens Village, L. I., 
New York. 

Chester Winfield Malmstead, M. D., Bangor, Maine. 


Book Reviews 


“Clinical Gastroenterology ’ 

By Horace Wendell Soper, M. D., F. A. C. P., St. 
Louis, Mo., with 212 illustrations. 

Published by The C. V. Mosby Company, St. 
Louis, 1939. Price, $6.00. 

This work is said to cover the field of gastro- 
enterology with special emphasis on diagnosis and 
treatment. The reader is never burdened with dis- 
putable measures. Only remedial agents and meth- 
ods which have been tried and found therapeuti- 
cally efficient are recommended. Every chapter 
that demands illustration of the clinical situation 
is richly supplemented with appropriate X-ray 
prints. The author takes a rather radical view 
concerning milk, raw and pasteurized. He employs 
neither of them as dietary agents. In his experi- 


ence, evaporated milk gave most satisfactory 
therapeutic results. There is an excellent chapter 
on the author’s emetine treatment for amebic dys- 
entery so successfully efficient that only one case 
out of 302 suffered from a recurrence; “emetine 
given as I have employed it is not toxic to the 
patient but is extremely toxic to the amoeba 
histolytica.” 


“Short Stature and Height Increase ” 

By C. J. Gerling. Published by Harvest House, 
New York, 1939. Price, $3.00. 

In a rather light vein and easy style, the reader 
is sharpened up to admire the ideal he-man, about 
six feet tall, well proportioned and standing erect. 


188 The Journal of the Maine Medical Association 


Every chapter, except the last one, reminds the 
short man that he is rather out of place and that 
he ought to try to feel, stretch, feed, drug, dress, 
build and think himself up to full man’s size. Only 
after the uphappy undersized man has been told 
in several chapters in how many ways he may try 
to deceive himself and others into believing him- 
self to be taller than he really is, are the blinds 
removed. In the very last chapter he is told what 
he already knew; namely, that after all, no one 
can really do very much about one’s stature, and 
that after all, a great many of the world’s famous 
men were and still are of short stature and are 
very successful in spite and because of it. 


“ Personal and Community Health ” 

By C. E. Turner, A. M., Sc. D., Dr. P. H. 

Professor of Biology and Public Health in the 
Massachusetts Institute of Technology; Formerly 
Associate Professor of Hygiene in the Tufts Col- 
lege Medical and Dental Schools; sometime mem- 
ber of the Administration Board in the School of 
Public Health of Harvard University and the 
Massachusetts Institute of Technology; Fellow 
American Public Health Association; Chairman, 
Health Section, World Federation of Education As- 
sociations; Major, Sanitary Corps. U. S. A. (Re- 
serve). 

Published by the C. V. Mosby Co., St. Louis; 5th 
Edition, 1939. Price, $3.00. 

This new edition is printed on eye-toned paper. 
The toning seems to consist of the addition of a 
small amount of blue coloring matter so that the 
reading surface presents a blue resembling the 
pale blue atmosphere of daylight. The gloss of the 
paper is reduced to a minimum. It has been said 
that the study of Hygiene is the same for any 
student regardless of where he studies. To study 
hygiene from Turner’s new fifth edition, however, 
seems to be promising better results than some 
others, judging from the fact that Turner is the 
standard text in many colleges and universities. 
The book is planned to take care of the needs of 
various college-level groups and seeks to present 
the most essential knowledge of personal and com- 
munity health which is in our possession at the 


present time. The text is based on instructions 
given for many years to students in schools of 
public health, medicine, dentistry, nursing, teach- 
ing, engineering, etc., and is still very well re- 
ceived everywhere. 

The author seems to be inspired in his teach- 
ing and writing by the belief that only by per- 
sistent efforts at educating ourselves and each 
other to properly care for our living body in all 
spheres can we hope to retard the workings of the 
rule for mankind which works so persistently effi- 
cient for the animal world; namely, that death is 
the rule and life the exception. Man can learn to 
postpone disease and death considerably as our 
knowledge concerning causes for and prevention 
of health-impairing agencies accumulates. 


“The Language of the Dream ” 

By Emil A. Gutheil, M. D. Published by The 
Macmillan Company, New York, 1939. Price, $3.50. 

The employability of a term like “scientific” in 
regard to anything we do and think worth while 
urges us on in our goal-striving labors. The inter- 
pretation of dreams, thought speculative in ancient 
times, is now considered highly scientific. The 
science of the language of the dream, however, is 
not like the science of mathematics, for instance, 
though both are said to be founded upon a solid 
body of facts and well formulated principles. 
Modern dream analysis began with Freucl about 
forty years ago. Since then, considerably more 
work has been done by Stekel, Adler, Jung, Rank, 
and many others. The author, who worked with 
Stekel for seventeen years, is convinced that there 
is great need for a new kind of book on dreams, 
one less lengthy than some and more instructive 
than others, one better suitable for American 
requirements. What he tried to do is to show as 
clearly and interestingly as possible that “Dream 
interpretation does not mean the successful appli- 
cation of a certain preconceived theory of the 
physician, but rather the discovery of mechanisms 
which give us a sufficient insight into the patient’s 
specific and individual mental situation. The more 
we bring out of an individual dream, the more 
quickly and completely we can attain our aim: 
that of curing the patient.” 


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XI 



Frequently patients become apprehen- 
sive over their failure to sleep and feel 
they must call the doctor. But the physi- 
cian, too, needs sleep. Often the prescrip- 
tion of a safe, effective sedative will save 
an unnecessary night call. 

The indiscriminate use of sedatives or 
hypnotics is not wise. Neither is it advis- 
able to withhold such medication when it 
contributes to the patient’s comfort and 
helps conserve his vital resources. 

Ipral Calcium has been used for four- 
teen years as a safe, effective sedative. It 
has the following advantages: 

... It produces a sleep closely resem- 
bling the normal from which the patient 
awakens generally calm and refreshed. . . . 
It is readily absorbed and rapidly elimi- 


nated. Its average therapeutic dose is small 
(2 to 4 grains). . . . Undesirable cumula- 
tive effects may be avoided by proper regu- 
lation of the dosage. . . . Even in larger 
therapeutic doses the effect on heart, circu- 
lation and blood pressure is negligible. 

Ipral Calcium (calcium ethylisopropylbar- 
biturate) is supplied in 2-gr. tablets as well as 
in powder form for use as a sedative and hyp- 
notic; and in %-gr. tablets for use where it is 
desired to secure throughout the day a con- 
tinued, mild, sedative effect. 

Ipral Sodium (sodium ethylisopropylbarbi- 
turate) is supplied in 4-gr. tablets for preanes- 
thetic medication. 

Elixir Ipral Sodium — Useful where a change 
in the form of medication is desirable. One 
teaspoonful of the elixir represents 1 gr. of 
Ipral Sodium. Available in 16-fl. oz. bottles. 


For literature address the Professional Service Department 
E. R. Squibb & Sons, 745 Fifth Are., New York, N. Y . 




XII 


Continued from page 172 


and that the abdomen was probably a sur- 
gical jmoblem, consideration was given to 
appendicitis as the underlying condition, but 
the findings were not consistent enough to 
make a definite diagnosis. After observation 
for a few hours there was not much doubt 
that the abdomen was the source of trouble 
and the most likely pathological process was 
a ruptured gangrenous appendix. 

On opening an abdomen and finding 
Regional Ileitis there is a difference of 
opinion as to how the cases should be 
handled, as you note in the above case, the 
surgical procedure elected was that of resec- 
tion with anastamosis. 

Since the Regional Ileitis was at the ter- 
minal ileum and there was a good portion 
distal to the infected area and the entire 
area easily mobilized this seemed an ex- 
tremely satisfactory case for a one stage 
operation. The patient did not, as reported, 
survive this procedure, but I believe a one 


stage operation if easily done is good 
surgery. 

In those patients who are poor surgical 
risks and in those where there is difficulty 
in easily resecting the infected area, a two 
stage palliative measure first either doing an 
ileocolostomy or some type of intra-abdomi- 
nal anastamosis and then later accomplish- 
ing the second stage, resection. 

We must also recognize that a chronic 
form of Regional Ileitis does exist but our 
comments are only on this case of the acute 
form. 

In operating upon a case of Regional Ilei- 
tis in the acute stage, we must not be content 
until we have inspected the entire intestinal 
tract for other similar lesions. A first stage 
ileostoma or an anastamosis would not ac- 
complish what we wish and expect it to do if 
an area of regional involvement left above 
results in an obstruction. 



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The Journal 

of the 

Maine Medical Association 

Dolume Thirty Portland, Blaine, August, 1939 No. 8 


Medico-Legal Problems * 

By A. Warren Stearns, M. D., Boston. Massachusetts. 


There are many situations in which medi- 
cine and law impinge upon each other. While 
there is probably no function of the doctor 
which may carry with it higher altruism or 
greater social need than assisting the law, 
this function of medicine rarely leads to dis- 
tinction and often to criticism. A brief dis- 
cussion of this matter may not be out of 
place. 

The theories of medicine and law are quite 
different. The doctor seeks the truth by a 
process of differential diagnosis. Arraying 
all the possibilities before him, he gradually 
eliminates those which have the weaker claim 
for consideration until finally the one having 
the least against it and the most for it sur- 
vives. Medical diagnosis is always tentative 
and can be changed if new information is 
available. Legal theory, as I have known it, 
is quite different. The truth is conceived as 
the resultant in the conflict of two opposites. 
Let one side amass all the information tend- 
ing to support its view, however partisan this 
may be, and let the other side do likewise, put 
them to a battle of words with a judge as the 
referee, and what survives is the truth. There 
is a finality about legal decision which is for- 


eign to medical. I shall not debate the rela- 
tive merits of these two methods except to say 
that I prefer the medical. 

So, the doctor called upon to assist, is fre- 
quently, one might say usually, called in to 
help build up one partisan view of the case, 
and insofar as he does this he tends to lose his 
medical role or standing, and to adopt a parti- 
san role, perfectly proper in the law but not 
so proper in medicine. Arising directly from 
this situation comes another, namely, the 
doctor’s claim to impartiality or disinterest- 
edness. There is a legal fiction which says 
that under certain circumstances the mind is 
impartial. I recall once when a man who had 
been defending insurance companies all his 
life and had been a bitter enemy to plaintiff 
lawyers and doctors, was elevated to the 
bench. I remarked to another judge that I 
thought it would be very hard for him to be 
impartial in a tort case with his background. 
The judge naively said, “Oho, but no, you do 
not understand. When one becomes a jndge 
he lays aside all those things.” One might as 
well say that he laid aside his whole life’s 
work and his mind and his body as to say that 
laying aside a prejudice was an act of the 


* Read before the Kennebec County Medical Society, at the Augusta State Hospital, Augusta, Maine, 
December 15, 1938. 


190 


The Journal of the Maine Medical Association 


will. And so it lias always seemed to me ab- 
surd for a doctor to claim philosophic detach- 
ment. I have tried many times to do this, and 
of course, we should all struggle to do it. 
Nevertheless, we should not be blind, but 
should recognize that the mere employment 
of a doctor as a witness according to the fund- 
amental reactions of human beings tends to 
make him become a partisan. Consciously or 
unconsciously his mind is inclined to favor 
the side upon which he is employed, and to 
look askance at that of the enemy. While 
every physician, in my opinion, should do his 
best to attain impartiality, let him not fool 
himself. Time and time again 1 have had to 
check my rising passions and say to myself 
that after all there are two sides to every 
question, and the other fellow may be right. 

Another word of warning. From my ob- 
servation it appears to me that the cases going 
to trial often represent a situation where the 
law is bound to give a decision on matters 
which are outside the border of scientific 
exactness. A doctor may procrastinate and 
may evade, he may even at times be so bold as 
to say, “I do not know,” but the court has to 
make a decision. It has to say “yes” or “no.” 
This often means that the doctor may prop- 
erly give his best judgment in spite of inade- 
quate data, but it ought never to take from 
him that glorious prerogative by which he 
may say, “I do not know.” 

Lastly, I wish to say that I have frequent- 
ly been able to orient myself without offend- 
ing a lawyer by saying to him, “My good 
friend, what I have to sell is advice, what 
you wish to purchase is service. Therefore 
we cannot do business together.” So often the 
legal mind honestly enough wishes only as- 
sistance in winning his particular battle. Oc- 
casionally the doctor may be so employed, but 
usually the lawyer should come to the doc- 
tor, set forth his case and ask his advice con- 
cerning the matter. If that advice fits in with 
the needs of the lawyer, well and good. If it 
does not, the matter should end there. Again, 
while it may be perfectly good ethics for a 
lawyer to take a case on a contingent fee, a 
doctor should never agree in advance to have 
the payment of his fee, or its size, contingent 
upon a successful verdict. There may be 
worthy cases in which it would be improper 
for him to insist upon guaranteed payment or 


payment in advance, but he will be more free 
in his judgments if he takes the cases as they 
come, renders his regular bill and hopes, even 
if he does not expect that he may be paid. 

With this preamble, let us run over briefly 
some of the situations in which the doctor’s 
aid is sought in legal matters. 

Criminal Responsibility 

By far the most dramatic situation arising 
in court is a murder trial. Theoretically it 
is important to determine the responsibility 
of the meanest offender, and yet one finds 
criminal responsibility questioned very, very 
rarely except in murder trials. This matter 
has been dramatized by the press and has 
come down from antiquity as a big show. 

From time immemorial the law has ex- 
cused irresponsible persons from punish- 
ment. In order to be punishable the culprit 
must have a mens rea, that is, a bad mind. If 
he is suffering from mental disease he can- 
not have a bad mind and therefore he cannot 
be punished. Now in the ordinary run of af- 
fairs when an out and out insane person com- 
mits murder, it is usually obvious to every- 
body, and in most civilized communities they 
are committed to a mental hospital forthwith 
and that ends the matter. Likewise, there are 
other cases so utterly devoid of any possibil- 
ity of an insanity defense that it is not raised. 
However, when there is no other defense 
it is usually possible to raise the question 
of the sanity of the culprit. It is 
likewise true that a great many murders 
are committed by borderline cases. The 
substantial, well-balanced good citizen is 
rarely brought to the bar of justice for mur- 
der. So it is the borderline case upon which 
medicine itself has often not made up a final 
judgment that is fought out in the courts. I 
suppose every condition which might affect 
one’s mind has probably in the past been 
brought before the court as an excuse for 
murder, but they tend to fall into relatively 
few categories. 

1. Psychoses. 

2. Intellectually defective individuals. 

3. Emotionally unstable, “Psychopathic 

personality” and “Constitutional inferior- 
ity.” 


Volume Thirty, No. 8 


Medico-Legal Problems 


191 


4. Drug and alcohol addicts. 

5. Paranoid personalities. 

6. Aged persons. 

7. Questions of epilepsy. 

How the law does not ash the doctor wheth- 
er or not the patient is sick, neither does it 
ask for a diagnosis of mental disease, but asks 
the physician certain metaphysical questions 
one of the commonest of which is, “Does the 
prisoner know the difference between right 
and wrong?” Most experienced doctors take 
a pragmatic view toward this. As a practical 
matter, if a patient is grossly feeble-minded 
or if he has mental disease of a type ordinar- 
ily called insanity, most doctors answer all 
questions in the negative, that is, they say he 
does not know the difference between right 
and wrong, he does not know the nature and 
quality of his act, he is not able to exercise 
sufficient self-control, he would not have com- 
mitted the act had be not had mental disease, 
and so on. O11 the other hand, if a sufficient 
degree of mental disease does not exist, wise 
doctors usually answer all the .other questions 
positively. Obviously, when a puppy, be- 
fore he has been trained, or in the process of 
training, has wet the floor he looks ashamed 
and shows every evidence of knowing that he 
has done wrong (or at least that he has done 
something punishable), while many a fa- 
natic, otherwise not considered insane, has 
little or no recognition of the fact that his 
misdeed is wrong. 

So my advice to the doctor is not to be en- 
snared by the metaphysical subtleties of legal 
opinion but to take a common-sense attitude. 

Another difficulty comes by necessity in the 
law. It must be all or nothing. In the eyes 
of the law a person is either one hundred per- 
cent insane or one hundred percent healthy 
minded. He must either be punished or not, 
and no other course is open, though in the 
question of disposition, degrees of mental im- 
pairment may properly be considered. It is 
folly for the doctor to rebel against this neces- 
sity and insist that liis patient is a little 
crazy because the law cannot entertain such a 
view. 

The intellectual development of an indi- 
vidual is generally considered on a gradually 
increasing scale. The idiot rates intellectual- 


ly at almost zero, and there is the normal 
adult level. Theoretically, there are all pos- 
sible gradations between these points. How 
according to all legal tests, if the intelligence 
is that of an infant or a wild beast, the per- 
son cannot be convicted. O11 the other hand, 
there is a zone ranging, we will say, 011 the 
intellectual scale between eight and twelve 
years where opinion very properly differs. 
Those who take a liberal point of view think 
that anybody who might be called feeble- 
minded ought to be excused for crime. Others 
feel that high grade feeble-minded persons 
after all as a practical social matter, should 
be held accountable for their acts. 

The courts have not definitely settled this 
matter by a formula, so that we find in cer- 
tain cases individuals with a fairly high I. Q. 
occasionally adjudged insane by courts. My 
own attitude has been formed somewhat from 
the circumstances of the individual case. Let 
us suppose that there is a mental age of ten 
years, but that the individual has always been 
childish in his behaviour, has perhaps been a 
bed wetter, has been dependent upon his fath- 
er and mother for support, and has been par- 
ticularly unstable emotionally. I can con- 
ceive of the propriety of saying that such an 
individual was insane. On the other hand, if 
he has been a person who has been about in 
society, who has had some schooling, who has 
worked steadily and who without extreme 
provocation gets involved in some malicious 
crime, one might properly say that he was to 
be held accountable. In other words, there 
are no exact criteria in these cases. One must 
conform to common practice in the commun- 
ity where he lives, but ordinarily only the 
lower grade feeble-minded are found to be 
not accountable. 

How as for the emotionally unstable. 
About one hundred years ago the concept of 
the moral imbecile was set up in England, 
that is, it was recognized that certain indivi- 
duals who were not insane and not feeble- 
minded were lacking in moral perception, 
they had a moral blind spot so that they did 
not know the difference between right and 
wrong. This was a very helpful sociological 
hypothesis, but worked very disastrously in 
the court because such a defense could be set 
up for almost anybody. The moral imbecile 
has largely disappeared. His place was first 


192 


The Journal of the Maine Medical Association 


taken by the psychopathic personality, then 
came constitutional inferiority, next consti- 
tutional psychopathic state, then characterial 
deviate, and finally the general term of per- 
sonality disorder includes him. Such persons 
are ordinarily not considered insane by the 
courts, though many of the great murder 
trials have come about by such a contention 
being set up as a defense. Many abnormal 
sex offenders come under this category. Their 
crimes are often startling and they are often 
obvious monsters who are dominated by mor- 
bid impulses. They are usually held to be ac- 
countable before the law. Although occasion- 
ally neurotics are committed as insane one 
rarely finds difficulty with them in criminal 
courts. 

Ordinarily a person under the influence of 
alcohol or drugs is not considered irresponsi- 
ble, the theory being that he has produced 
this condition through his own voluntary act 
and therefore cannot be held excusable. Often- 
times combinations of mental defect, person- 
ality disorder and drunkenness so obscure the 
real fact that a substantial defense is made. 
Cases of delirium tremens frequently cause 
confusion. The tendency of the law is to re- 
gard them as responsible, although, of course 
most physicians would consider a frank case 
of delirium tremens as utterly irresponsible. 

There are certain morbidly contentious 
personalities in the community who always 
have a chip on their shoulder and who tend 
to quarrel with society. They are popularly 
considered as “nuts’' and when such an indi- 
vidual gets into a broil and murder or some 
other serious crime results, the police and 
public are apt to consider that they are crazy. 
This often leads to great difficulty. My own 
judgment is that only those should be con- 
sidered insane where the natural history of 
their disorder shows some definite form of 
mental disease. However quarrelsome a man 
may be, this of itself should not constitute 
insanity. 

Nothing is more pathetic than to see an 
aged person brought before the courts, usual- 
ly for a crime of a sexual nature. As age ad- 
vances, with a waning or loss of sex ability, 
there is often a persistence of sex interest or 
desire. This often leads to attacks upon chil- 
dren or other helpless individuals. Often- 
times there is little intellectual decay, and 


yet my judgment has always been that where 
such an act represents a departure from a 
healthy state of the individual’s mind and 
conduct, he should be held to have senile 
dementia. 

A common claim before the courts is that 
the individual was suffering from an attack 
of epilepsy. This usually depends upon two 
things, in the first place a well established 
history of epilepsy, and secondly, evidence 
that the person was actually in an attack. 
This brings up the ever vexing question of 
amnesia. The so-called amnesia victim fre- 
quently comes before the court. Such a claim 
is usually considered fictitious by police and 
lawyers, and this is especially true of the 
alcoholic. Of course, if a man says he doesn’t 
remember, the debate is at an end. There is 
no rule to go by. Epileptics ordinarily do 
have complete amnesia for their attacks. Hys- 
terics and alcoholics rarely, though some- 
times, have amnesia. It is to be assumed that 
if a person either through head injury, epi- 
lepsy or what not, actually was in an auto- 
matic state so that he did not remember, he 
is to be considered as incompetent. 

Guardian and Conservatorship 

Generally speaking a conservator has cus- 
tody of the property of the individual, and 
the guardian has custody of the person and 
property. This conies up most often under 
two circumstances, either a defective or some 
type of an aged person. The latter is espe- 
cially important. It is unfortunate that one 
of the most important acts of a person’s life 
is often called for at a time when he is least 
able to perform it. In the midst of the old- 
fashioned home, old people may live with 
their children and gradually dement. Altru- 
ism and a high sense of honor indicate the 
attitude of all concerned and the person goes 
to his end, the property is distributed ac- 
cording to his known wish, and there is no 
litigation. But oftentimes such is not the 
case. Old people rarely live with their chil- 
dren at the present time. The families of 
their children may be entire strangers, and 
so there is a conflict of interest. Loving chil- 
dren hesitate to apply for a guardian or con- 
servator fearing to offend the old people. 
Alas, only too often the barn is locked after 


Volume Thirty, No. 8 


Medico-Legal Problems 


193 


tlie horse is stolen. So many times I have 
been called in after an aged person has trans- 
ferred all his property, married the cook or 
nurse, or made a will disastrous in its effect. 
One of the qualities of old age is emotional 
instability. The hand that feeds them, the 
voice that is nearest, often tends to be the one 
that is dearest. Out of sight, out of mind, is 
often the case. Too often the child who is 
nearest is perfectly conscientious in assisting 
the parent to transfer his property to him. 
The rights of the other heirs are considered 
merely technical. Physicians can often be of 
great assistance in helping the family over 
this difficult period, but somebody should be 
courageous and insist upon protection where 
it is obviously needed. 

T ESTAMEVTARY CAPACITY 

Testamentary capacity before the law is 
not svnonomous with sanity. I have fre- 
uently been in court and heard the various 
decisions read defining testamentary capacity 
only to observe that any person in a state 
hospital might come within the scope of what 
is considered competent. Here again there is 
quite a bit of legal fiction. An out-moded 
psychology has formed the basis of frozen 
opinions. A person to have testamentary ca- 
pacity must know the nature and extent of his 
property, he must know those who have a 
claim upon his bounty, and he must have suf- 
ficient mentality to put this knowledge into 
appropriate action. Alas, who can tell. Deci- 
sions are inevitably made upon inference 
drawn usually from very inadequate data. 
A11 old man in the eighties, dying of broncho 
pneumonia, asks the nurse to get his bank 
books from his trunk. She procures them. I11 
a burst of gratitude for what she has been 
able to do for him, and with some help he 
signs his name transferring the books to her. 
She is grateful and tucks them away. The 
next day the old man is dead. His children 
after an appropriate time search his effects. 
They thought he had some money, but it ap- 
pears that he had not. At last they discover 
that the nurse has the money, several thou- 
sand dollars. They are obliged to pay his 
bills. There is nothing for them. Did the old 
man know what he was doing? Was he com 


petent ? He had never been considered in- 
sane before. There is ample testimony of his 
mental vigor just a few weeks earlier. 1 ST 0 
one saw him the day of the act except the 
nurse. The doctor came in for a minute, said 
good morning, and states that he seemed to 
know what he was about. Yet was he capable 
of evaluating the rights of his children and 
the comparative meagerness of the contribu- 
tion of the nurse of a week to his total happi- 
ness. Reason cries out emphatically no. The 
law often technically says ves. What shall we 
do about this? Here again there is no higher 
function of the medical profession than to 
furnish skilled, accurate, complete and honest 
evidence in such a case. The doctor should 
never assume the role of lawyer. Xothing is 
more disgusting than to see a doctor snooping 
around trying to regulate the affairs of his 
patients in all their details, and yet to stand 
by uninformed, like a jellyfish, and see an 
old man who, in fact loves his children, leave 
his heirs destitute because of a momentary 
impulse, because the doctor did not inform 
himself as to the mental condition of his 
patient, is tragic. The doctor’s glance or 
casual opinion is often no better than a street 
car conductor's. Generally speaking, the doc- 
tor's opinion is better than that of other per- 
sons because he has more facts. So let me say 
it seems to me that every physician having to 
do with an aged person, whether a guardian- 
ship or a will is concerned, is duty bound to 
keeji his eyes and ears open. So many times 
the doctor, while attending an old person, is 
called in a hushed voice into another room 
and there a paper is put before him purport- 
ing to be the last will and testament of the 
individual, and he is asked to sign as a wit- 
ness while the old man makes a scrawl. The 
doctor has pictures of the old man in the 
prime of his life. He recognizes the doctor 
when he enters the room, what he says is all 
right, and to the point. But there should be a 
more extended exploration of the person’s 
mental capacity and an evaluation of the vari- 
ous stresses that are playing upon him and of 
his emotional reaction and the good faith of 
those who are participating, whether lawyer: 
or beneficiaries. Then and then only can the 
doctor give a worthy opinion. 


The Journal of the Maine Medical Association 


194 


Contracts 

Mental disease is often associated with ad- 
vanced arterio-sclerosis hut, the existence of 
arterio-sclerosis is not evidence of mental dis- 
ease, and neither are other evidences of physi- 
cal illness. The doctor must judge after ade- 
quate investigation of the working of the 
mind of his patient, if he is to be of assist- 
ance. This is often particularly difficult in 
cases of aphasia. Similar causes apply to the 
ability to make a contract, especially the mar- 
riage contract. Courts, in general, are pretty 
liberal in the matter of marriage. I have seen 
a marriage declared valid by the courts when 
four days after it had taken place the woman 
did not remember the name of her husband. 
Old people are very susceptible to flattery and 
to attention from young persons of the oppo- 
site sex, and it is much better to have a 
guardian appointed prior to an improper 
marriage than to attempt to have the mar- 
riage annulled afterwards. 

Suicide 

There is a general assumption that a per- 
son must be insane if he commits suicide. 
This is not warranted. In a study I made a 
number of years ago, it appeared that about 
one-third of the suicides in Massachusetts 
were frankly insane. Another third had some 
evidence of psychopathy, while the final third 
represented persons, otherwise healthy-mind- 
ed, who had been subjected to terrific stresses 
from overwhelming situations. Suicide as a 
cause of death results in one of the largest 
claims against insurance companies. These 
companies try to protect themselves by hav- 
ing a clause in their policies excluding sui- 
cides, yet they make very little investigation, 
tending to exclude potential suicides. As a 
matter of fact, this is a very difficult matter 
to guard against. Insurance companies, ad- 
vised by lawyers and surgeons, regard the 
problem as one consisting largely of indivi- 
duals who have determined to kill themselves, 
and who then seek insurance policies. This 
is rarely the case. What happens is that some 
person who has carried a large policy for 
many years either through advanced age or 
illness becomes somewhat enfeebled and des 
titute. He finally becomes haunted by the 
idea of the insurance policy. It would be 


much more reasonable for insurers to keep 
track of their large policy holders in their 
later years, rather than try and anticipate 
suicide claims by excluding those who intend 
to kill themselves. 

Tort 

1 shall discuss but two of the neuro-psy- 
chiatric conditions which frequently result 
in actions of tort, namely head injuries and 
neurosis. Head injuries have become of in- 
creasing importance due largely to the advent 
of the automobile with its high rate of speed 
and frequent accidents. I11 court, attention is 
often focused upon the question of whether 
or not the skull has been fractured. Actually 
this is of little importance. A much more 
fundamental question is the degree to which 
the brain has been injured and the extent to 
which recovery has taken place. Of course, 
common-sense would indicate that there is 
more likelihood of serious brain damage in 
an extensive injury with prolonged uncon- 
sciousness, but this is not always the case. 
Frequently serious injuries with prolonged 
unconsciousness and many neurological signs 
are followed by complete recovery. Like- 
wise, supposedly minor injuries are often 
followed by prolonged illness and disability. 
Cases with fractured skull, unconsciousness, 
neurological signs, and bloody spinal fluid 
may clear up promptly and the individual re- 
turn to work in a few weeks or months and 
have no further trouble. Such cases are en- 
titled to compensation on the same basis as in 
the case of any other injury, that is, the 
amount of suffering involved and the amount 
of time lost from work. They are not en- 
titled to compensation for possible or conjec- 
tural future mental trouble. 

There is another type of case with similar 
symptoms which does not recover. There may 
be a residual dementia with intellectual loss, 
disability, paralysis, epileptic attacks, and 
what has latterly been called the traumatic 
constitution. The first three are usually fair- 
ly obvious, though claims of unconscious at- 
tacks should be scrutinized with great care 
lest the patient be deprived of his just deserts 
where actual epilepsy has occurred, or the in- 
surer or other defendant been penalized on 
account of supposed epilepsy which is in fact 


Volume Thirty, No. 8 


Medico-Legal Problems 


195 


a pure emotional disorder. Functional ner- 
vous disease, that is, subjective complaints 
without demonstrable pathology, may occur 
following head injury as well as in any other 
case. Aside from this there are certain indi- 
viduals who have obvious brain damage and 
who make a superficial recovery but have a 
persistent enfeeblement of their mental pro- 
cesses resulting in marked disability. It is 
almost impossible to differentiate this con- 
dition from a neurosis. The persistence of 
symptoms without marked emotional disturb- 
ance point toward an organic basis for such 
complaints. 

Many lawyers smile when the words “trau- 
matic neurosis" are uttered in court or by a 
physician. This does not seem to me a good 
term because it not only makes a medical but 
a legal diagnosis. It is perfectly proper for a 
doctor to make a diagnosis of neurosis and to 
sav that in his opinion the alleged accident 
was an adequate cause, but it is a function of 
the court to determine whether or not it is in 
fact a traumatic neurosis. This is often the 
purpose of the trial. Unfortunately there are 
no criteria which enable a physician to say 
with one hundred percent assurance that a 
person is suffering from a neurosis due to an 
accident. The complaints usually have an 
emotional background making for exaggera- 
tion and dramatization. The signs and symp- 
toms present are largely subjective so that in 
the last analysis we are dependent upon a 
thorough knowledge of the situation and upon 
good faith on the part of the patient and the 
attorney. I think it is better to proceed in 
the examination of such cases as if there had 
been no accident. A careful inquiry should 
be made as to the background of the patient. 
There should also be an appraisal of his per- 
sonality and nervous stability, and perhaps 
most important of all, an inquiry as to his 
situation at the time of the accident. There 
is usually, in my opinion, some evidence of 
constitutional nervous instability and there 
is evidence, frequently, of other causes of 
emotional unrest preceding the accident. A 
woman of thirty-five, whose husband died a 
number of years ago leaving her with a large 
family to support, worked assiduously in a 
mill trying to keep the brood together. There 
had been continual economic stress and much 


sickness among the children, yet she carried 
on at her work until the day of the accident 
without medical attention herself. She then 
slipped on a grease spot on the floor and had 
comparatively little physical injury. From 
then 011 she continuously complained of in- 
somnia, headaches, coccygeal pain, shortness 
of breath, lassitude and many other symp- 
toms commonly found in the neuroses. In 
other words, we have the stage all set for an 
emotional collapse awaiting any one of many 
stimuli which may precipitate a more or less 
chronic nervous disorder. I11 such a case, I 
have no doubt as to the genuineness of the 
disorder and have no hesitancy in asserting 
this belief in the courts. O11 the other hand, 
we frequently see unstable individuals, per- 
haps irregularly employed, who have had no 
such preparation for a neurosis, and who 
have an accident, perhaps not very clearly 
defined and who later complain of a lame or 
weak arm or back without the general symp- 
toms of a neurosis. In these cases it seems 
more likely that the patient is trying to ex- 
ploit a minor injury for purposes of gain. 
Such cases require great wisdom, absolute 
honesty and cautiousness on the part of the 
physician. 

Accident as a cause of insanity is relatively 
infrequent. Where it is evident that there 
was a gross brain injury and acute mental 
symptoms develop in the course of convales- 
cence, there would seem to be little doubt as 
to the relation. 

There are those who believe that injuries 
may precipitate paresis or tabes in a person 
with syphilis. I am, personally, very doubt- 
ful about such cases. Again, where relatively 
minor injuries occur and mental symptoms 
come on some little time after such accidents 
I think it unreasonable to attach a causal re- 
lationship. There are certain aged persons 
with evidence of vascular disease who do not 
come back following severe injury, even 
though physical recovery may seem to be 
complete. 

I am very happy to have had the oppor- 
tunity to meet the members of the Kennebec 
County Medical Association. I have enjoyed 
reviewing with you a few of the situations in 
which it becomes necessary for medicine and 
law to cooperate. 


The Journal of the Maine Medical Association 


1 96 


Sulfapyridine Therapy in Pneumonia* 

By Louis A. Parrelra, M. I)., and E. E. Brown, M. L)., Lewiston. Maine 


The recent clinical successes of sulplianila- 
mide in the treatment of streptococcal, 
meningococcal and gonococcal infections has 
furnished a new stimulus for the study of 
chemotherapeutic agents in the treatment of 
disease. From these numerous studies sulfa- 
pyridine has emerged as a valuable drug be- 
cause of its effectiveness against pneumococci. 

Whitby in 1938 using this sulfapyridine 
was among the first to notice the protection 
against pneumococci afforded by this drug in 
mice. These results were confirmed both in 
vivo and in vitro by A. Fleming who also 
found that the action of the drug was bac- 
teriostatic rather than bacteriocidal in action. 
Therefore the actual killing of the bacteria 
had to be done by the natural defenses of the 
body and he proved, too, that this action 
could be greatly enhanced by the use of type 
specific serum. Recent clinical surveys do 
not appear to have made much use of this 
fact. Perhaps the investigators want to try 
the effect of the drug alone in pneumonias. 
We have used both drug and type specific 
serum in two of our cases which will be 
included in this paper. 

After reviewing some of the current litera- 
ture it can be safely stated that the dosage of 
this drug in the treatment of lobar pneumonia 
is fairly well stabilized. Most men have 
found from clinical experience and case 
studies that one hundred and twenty grains 
in divided doses during the first twenty-four 
hours have produced desired clinical results 
with blood levels ranging from five to ten 
milligrams per cent, and that these levels 
could be maintained by giving ninety grains 
daily until the temperature had remained 
normal for forty-eight hours. The dosage 
could then be cut to sixty grains a day for 
several days and then the drug could be dis- 
continued. Higher blood levels have failed to 
produce better results. Sulfapyridine is very 
insoluble and is not absorbed evenly so that 
stipulated amounts will not produce the same 
blood level in all patients. For this reason 
the dose may have to be varied with the pa- 


tient. Higher doses are advised when the 
temperature does not come down fairly 
rapidly. It has been the practice of some 
men, notably Meakins and Hanson of Mon- 
treal, to give ten grains of sodium bicar- 
bonate not only to bring about more regular 
and more rapid absorption, but also to relieve 
some of the nausea and vomiting which the 
drug may produce. It might be mentioned 
that MacLean, Rogers and Fleming of St. 
Marie’s Hospital in London have experi- 
mentally proven that pneumococci can estab- 
lish a tolerance or fastness to the drug in 
infected animals. They therefore recom- 
mended strongly that the initial doses of the 
drug be large. 

In most of the cases treated at our hospital 
the dosage generally employed was slightly 
less than that advocated above ; namely, 
ninety grains the first twenty-four hours, 
sixty grains the next twenty-four to forty- 
eight hours, and then forty grains daily until 
the temperature was normal for four or five 
days. 

The most serious difficulty encountered in 
the use of sulfapyridine in our series and in 
those recently reported was the frequency 
with which it produced anorexia, nausea and 
vomiting. Almost all of the patients had this 
complaint at one time or another during the 
course of its administration. Graham et al. 
of Toronto have found that most, patients 
tolerate the drug better if the tablets are 
crushed and given in the form of a powder in 
water, milk or fruit juices accompanied by a 
small dose of sodium bicarbonate. We tried 
this in two of our cases without success. In 
pronounced nausea and vomiting Graham 
states that these symptoms may be controlled 
by such sedatives as paraldehyde or chloral 
hydrate and bromides given by rectum. O 11 
several occasions he found it necessary to 
pass a duodenal tube not only to give the 
drug but also to maintain the nutrition of 
the patient. Other men have administered 
the drug rectally suspended in water or intra- 
muscularly suspended in oil where nausea 


* Read by Dr. Brown at the staff meeting of the Central Maine General Hospital, May 1, 1939. 


Volume Thirty, No. 8 


Sulfapyridine Therapy in Pneumonia 


197 


and vomiting were severe. However, it was 
impossible to attain a blood level of over two 
milligrams, although the doses were exceed- 
ingly high. The use of the soluble salt of 
sulfapyridine (the sodium salt) intrave- 
nously has been suggested in order to avoid 
the nausea and vomiting usually produced. 
A recent work showed that these distressing- 
symptoms occur about as frequently even 
when the drug is given intravenously in the 
form of the soluble sodium salt. 

Other toxic manifestations reported in the 
literature were not seen in our small series of 
cases. Moderate methemoglobinemia has been 
reported in several cases although it has 
rarely been severe enough to cause any 
marked color changes in the mucous mem- 
branes or the finger tips. Severe cases of 
methemoglobinemia were treated by giving 
methylene blue intravenously. Since there 
was no significant improvement of the pa- 
tient clinically, it was decided that the 
methemoglobinemia due to the drug was not 
the cause of a serious disturbance to the pa- 
tient and that the methylene blue treatment 
was unnecessary. In a control group of pneu- 
monia patients it was shown that the inci- 
dence of cyanosis was as high in the patients 
not receiving sulfapyridine as in those receiv- 
ing the drug. 

The consensus of opinion seems to be that 
there is a moderate fall in hemoglobin and 
red cell counts but that this did not exceed 
the expected fall in any infectious disease. A 
small proportion showed a slight but definite 
depression of the total white count with poly- 
morphonuclear leucopenia. Granulocytopenia 
developed in one patient who had received 
seventy-nine grams of the drug in nineteen 
days. His total white blood count was 900 
with eight per cent, polymorphonuclear cells 
in the diffential count. When the drug was 
interrupted this patient made a good recov- 
ery. It will be noted that seventy-nine grams 
is about three times the total amount given to 
the average serious case of pneumonia. 
Where prolonged treatment is contemplated 
or large doses of sulfapyridine are to be 
given, the white blood count should be 
watched closely. 

In a series of one hundred and eight cases 
reported from the City Hospital of London 


six patients developed rashes in from three 
to fourteen days after treatment was started. 
Two patients of a series of thirty in Toronto 
developed rashes. These eruptions were either 
of a morbilliform or scarlatinal type. With 
discontinuance of the sulfapyridine therapy 
the rashes quickly disappeared. Ho mention 
of jaundice as a toxic manifestation is made 
in the literature. 

Graham of Toronto recently reported four 
patients who showed gross hematuria which 
was usually accompanied bv ureteral pain. 
Ho casts were present in the urine and the 
blood disappeared completely in a few days 
without evidence of residual damage to the 
kidney. The cause of this hematuria has not 
been determined, but the presence of large 
numbers of jagged crystals of the drug in the 
freshly voided urine suggests this as a pos- 
sible cause. 

The only toxic elfect on the nervous sys- 
tem noted in several large series of cases was 
transient mild mental confusion in a few of 
the patients. 

In quite a few of the cases reported and in 
our few cases a secondary pyrexia occurring 
between the third and tenth day was ob- 
served. This was accompanied by a rise in 
the total white blood count. Too early with- 
drawal of the drug or an extension of the 
pneumonic process has been offered as an 
explanation for this phenomenon. Secondary 
pyrexia due to drug fever has also been ob- 
served in a few cases. Drug fever may be 
distinguished from the first type of pyrexia 
mentioned by the absence of a leukocytic re- 
sponse and the failure of the fever to subside 
following increased doses of sulfapyridine. 

In comparing the treatment of pneumonia 
with sulfapyridine and serum, one notes cer- 
tain obvious advantages of therapy with M. & 
B. 693. The necessity of typing sputum is 
eliminated. Although it might be of academic 
interest to know whether it is a pneumococcal 
pneumonia that one is dealing with, response 
to the use of this drug would give one an 
indication of the infecting organism. (It 
may be stated here parenthetically that if 
typing is to be done, it should be done before 
treatment with sulfapyridine is started be- 
cause the organisms are affected by the drug. 
Subsequent typing becomes difficult as the 


198 


The Journal of the Maine Medical Association 


membrane surrounding the pneumococcus is 
disturbed so that bizarre quellung reactions 
are noted. We had this experience with one 
of our cases. ) Serum therapy must be started 
at least within seventy-two hours of the onset, 
whereas with drug therapy the duration of 
the disease when treatment is begun is not 
of much importance. Serum-sensitive pa- 
tients are no longer a problem because sulfa- 
pyridine may be used instead. The simplicity 
of this drug treatment is a great, advantage. 
Immunotherapy requires frequent intrave- 
nous administrations of the serum and con- 
sequently the physician must be in almost 
constant attendance over a period of twelve 
hours or more while the treatment is carried 
out. This drug, however, is given orally and 
does not require such close supervision. With 
serum therapy a patient may be made serum 
sensitive so that any future immunotherapy 
may present serious dangers and problems. 
Among the disadvantages one might list the 
toxic effects of the drug, among which nausea 
and vomiting are the most common and dis- 
tressing. This may not necessarily preclude 
the administration of the drug. Experi- 
mentally it has been shown that some strains 
of pneumococci are insensitive to the drug so 
that conceivably in some types of pneumonia 
sulfapyridine may be ineffective. 

The following are brief case summaries of 
six patients on our Medical Service who 
were treated with sulfapyridine : 



Case I 

This was a twenty-six-year-old married 
female with type VIII lobar pneumonia (left 
lower lobe) who was severely ill on admis- 
sion. Her white blood count at that time was 
21,500 with 92% polys. Treatment with M. 
& B. 693 was begun immediately on what 
was the fourth day of her illness. As her 
temperature fell within twenty-four hours, 
the dose of sulfapyridine was reduced. On 
her third hospital day the temperature was nor- 
mal and her white blood count was 8,800 with 
66% polys. The next day the patient devel- 
oped a secondary pyrexia with a rise in white 
count to 26,500 with 91% polys. Consider- 
ing this a flare-up or an extension of the 
pneumonic process we increased the dose of 
sulfapyridine and then gradually decreased 
it and finally discontinued it on the tenth 
hospital day. During the administration of 
the drug nausea and vomiting were observed. 
Supportive treatment, including two small 
transfusions, was given. The total dosage of 
sulfapyridine was twenty-seven grams. She 
made a good convalescence and was dis- 
charged on her nineteenth hospital day. 

In this case a fairly typical response to the 
drug is exemplified. Following a secondary 
pyrexia which was controlled by increased 
dosage she made a good recovery though she 
was very sick on admission. The transfusions 
were given to speed up her convalescence and 
because she had developed a moderate sec- 
ondary anemia. 



Cask I 


Case II 


Sulfapyridine Therapy in Pneumonia 


1 99 


Volume Thirty, No. 8 

Case II 

The patient was a forty-seven-year-old 
married female who was moderately ill on 
admission. The sputum was not typeable and 
the blood culture was negative. A lobar pneu- 
monia of the right lower lobe was found. 
Sulfapyridine therapy was instituted imme- 
diately on what was the tenth day of her ill- 
ness and the total dose given over a period of 
ten days was twenty-six grams. Her tem- 
perature became normal within twelve hours 
and remained essentially so throughout her 
hospital stay. The only toxic manifestation 
was nausea and vomiting which were not 
distressing. She was discharged on her 
eighteenth hospital day improved. 



This was a thirty-one-year-old married 
female who entered the hospital on the third 
day of her illness with a lobar pneumonia of 
the left lower lobe. She was moderately ill on 
admission and responded immediately to 
sulfapyridine. A dose of twenty-two grams 
was given over a period of eight days. Here 
again there was mild nausea and vomiting. 
She made an uneventful recovery and was 
discharged on her sixteenth hospital day. 
The blood culture in this case was negative 
and the sputum was not typeable. 



A thirty-nine-year-old female who was 
moderately ill entered the hospital on the 
fourth day of her illness. Physical examina- 
tion showed evidence of rheumatic heart 
disease and a bronchopneumonia which was 
confirmed by x-ray. The sputum was nega- 
tive for typing. Her temperature gradually 
came down and was normal on the fifth hos- 
pital day after a total dose of thirteen and a 
half grams of the drug had been given. On 
the insistence of the patient she was dis- 
charged on the sixth hospital day to continue 
her convalescence at home. 

kSix days later she re-entered the hospital 
because twenty-four hours before she had 
developed chills, fever and productive cough. 
This time she showed consolidation of the 
right and left sides of the chest. She was 
given only one dose of sulfapyridine, follow- 
ing which the drug had to be discontinued 
because within four hours of admission she 
developed extensive pulmonary edema and 
became moribund. In spite of intensive sup- 
portive treatment she expired twelve hours 
later. The sputum was not typeable. The 
white blood count at the time of her second 
admission was 22,900 with 81% polys and 
on the day of her death it was 48,000 with 
91% polys. 

An autopsy revealed large heavy lungs, of 
which the right one weighed 960 grams and 
the left, 850 grams. On section all lobes were 
consolidated and presented a dark red, firm, 


200 


The Journal of the Maine Medical Association 


rubbery surface from which a considerable 
amount of frothy fluid could be expressed. 
The bronchioles when sectioned showed a 
deposit of frothy pinkish fluid with the 
mucosa markedly injected. A marked mitral 
stenosis and definite rheumatic lesions were 
also demonstrated in the heart. 



This was a forty-five-year-old married 
female who was desperately ill when ad- 
mitted to the hospital. Type I pneumococcus 
was found in her sputum and the blood cul- 
ture was negative. Because of her serious 
condition we decided to use both the drug 
and serum in this case. 120,000 units of type 
specific serum was given over a period of 
twelve hours and sulfapyridine therapy was 
instituted on the third day of her disease. 
The temperature became normal within 
twelve hours but twenty-four hours later it 
had risen to 102 degrees. We attempted to 
give her more serum but could only give her 
20,000 units because she developed a mild 
reaction after receiving that amount. The 
dosage of sulfapyridine was increased, fol- 
lowing which the temperature became normal 
on the fourth hospital day and remained so 
until the eighth and ninth day, when she 
developed a transient secondary pyrexia. On 
the sixteenth hospital day the patient devel- 
oped a phlebitis of the right saphenous vein 
from which she had almost r< 'covered a week 
later. At this writing there are no signs of 
pneumonia present and since the patient has 


made a satisfactory convalescence she will be 
discharged shortly. A total dosage of thirty- 
two grams of sulfapyridine was given over a 
period of fourteen days. 



Case VI 

Case VI 


The last patient in this series is a sixtv- 
year-old married female who was desperately 
ill on admission to the hospital. She had had 
pneumonia on five previous occasions and her 
last attack had occurred five years ago. For 
the past two years she had been on a special 
regime because of hypertension. Her blood 
culture was negative and her sputum showed 
type T pneumococcus. 200,000 units of type 
specific serum were given over a period of 
twenty-four hours and sulfapyridine therapy 
was instituted on the third day of her illness. 
About ten hours after entry the patient 
showed increasing dyspnea and signs of pul- 
monary edema. She was digitalized rapidly, 
given oxygen intranasally and other sup- 
portive measures. Responding well to this 
treatment her temperature became normal on 
the fourth hospital day and after varying a 
few degrees for several days it remained 
normal until a week later when a transient 
secondary pyrexia was noted. This reacted 
well to increased dosage of sulfapyridine. 
Four days later the patient complained of 
pain in her ankles, knees and wrists which 
was not accompanied bv a rise in tempera- 
ture or physical signs. Although no mention 
of joint pain as a toxic manifestation of 
sulfapyridine could be found in the litera- 


Volume Thirty, No. 8 


Sulfapyridine Therapy in Pneumonia 


201 


ture, the joint pains in this case disappeared 
when the drug was discontinued. The re- 
mainder of the patient’s convalescence was 
uneventful and she was discharged on her 
twenty-fifth hospital day. The total dose was 
thirty-five and one-half grams. 

General toxicity from her infection and a 
delayed serum reaction were also thought of 
as possible etiological factors for her joint 
pains. A combination therapy was used in 
the last two cases because the patients were 
seriously ill when admitted to the hospital. 

In conclusion there are certain points that 
may be emphasized. Though this drug 
quickly produces an afebrile state and short- 
ens the course of the disease slightly, the 
course of the pathological process is relatively 
unaffected. A secondary pyrexia three to ten 
days later appears to he a very common ex- 
perience and responds to further therapy. 
As for toxic manifestations, nausea and 
vomiting are very frequently present though 
others, such as drug fever, hematuria, cya- 
nosis, agranulocytic leukopenia, various skin 


eruptions and mental confusion, may be occa- 
sionally encountered. It would seem that 
there is a place for a combination of both 
chemo- and immunotherapy, especially in the 
serious cases. The work of Fleming has 
showed sound scientific basis for this com- 
bi nation therapy. 


References 

1. S. C. Dyke & G. C. K. Reid. Lancet , Nov. 19, 

1938, Vol. 235, No. 6012. 

2. Gunnar Alstead, M. D. Lancet , April 15, 1939, 
Vol. 236, No. 6033. 

3. Royal Section of Medicine. Lancet, April 8, 

1939, Vol. 236, No. 6032. 

4. MacLean, Rogers & Fleming. Lancet, March 
11, 1939, Vol. 236, No. 6028. 

5. Graham, Warner, Dauphinee & Dickson. Cana- 
dian Med. Journal, April, 1939, Vol. 40, No. 4. 

6. Meakins & Hanson. Canadian Med. Journal, 
April, 1939, Vol. 40, No. 4. 

7. W. A. MacColl. Journal of Pediatrics, March, 
1939, Vol. 14, No. 3. 

8. Wilson, Spreen, Cooper, et al. Journal of the 
American Medical Association, April 15, 1939, Vol. 
112, No. 15. 

9. Long. Journal of the American Medical Asso- 
ciation, April 26, 1939, Vol. 112, No. 17. 


1. The early symptoms of cancer of the 
throat are mostly trivial : — 

(a) abnormal sensations in the throat, 
characteristically persistent and well local- 
ised ; 

(b) changes in the voice; 

(c) enlarged cervical glands. 

2. Persistent dysphagia is a late symptom 
except in post-cricoid cancer. 

3. Examination with the laryngeal mirror 
is essential in cases presenting such symp- 
toms and is the only readily available meth- 
od of detecting an early cancer. — Robin 
Pilcher, M. S. Taken from Medical World, 
London, April 8, 1039. 


A lien irradiation for corpus carcinoma is 
reserved for the patients who are considered 
very poor surgical risks, the results obtained 
from this therapy cannot be very brilliant. 
However, something has been accomplished 
in this group of patients in the form of an 
arrest of the disease in some and of palliation 
in others. In all, it has controlled the bleed- 
ing, it has stopped the foul vaginal discharge, 
of which they complained, and it has given 
them comfort by lessening their pain. This 
part of the treatment has been worthwhile. 
— Loris E. Phaneuf, M. T)., The Am. Jour, 
of Roentgenology and Radium Therapy, 
June, 1938. 


202 


The Journal of the Maine Medical Association 


The Pneumococcus and Sulfanilamide 

REPORT OE TWO CASES 
By Harold I. Goldman, M. I)., Freeport, Me. 


In the past one and one-lialf years the lit- 
erature has been deluged with reports on the 
chemical action, theory, and results obtained 
with sulphanilamide. There have been nu- 
merous reports on the results obtained in 
pneumococcus infections, both by the drug 
alone and also in conjunction with serum 
therapy. 

Millet (1) reported one case of Type III 
in which good results were obtained with the 
drug given orally; Mertins (2) a case of 
pneumococcus meningitis following a middle 
ear infection and operation and recovery; 
Heinzelman, Hadley, and Mellon (3) in 
Type III nine cases treated with Prontylin 
had a 22% mortality, while in ten cases 
where the drug was not used the mortality 
was 80% ; Caldwell and Byrnes (I) report 
a recovered case of pneumococcic meningitis 
where the drug was given orally and intra- 
muscularly; Millet (5) a case of pneumo- 
coccic meningitis where the drug was given 
intrathecally. In this instance the patient 
died and subsequent necropsy showed no 
demonstrable injury to the brain substance. 
Recently Price and Myers (6) report a series 
of 115 cases of pneumococcic pneumonia 
treated with sulphanilamide in uniform 
doses, 40 controls with Felton serum, 94 
controls with no specific therapy. They had 
a mortality rate of 15.7% for the sulphanila- 
mide group, 30.8% for the entire control 
group. In Types I, II, V, VII, VIII, the 
mortality rate was 10.5% for the sulphanila- 
mide group and 27.5% for the serum group. 
Hewell and Mitchell (7) report six cases of 
pneumococcic meningitis treated with sul- 
phanilamide with three recovering com- 
pletely. 

Following are two case reports in which I 
was able to get the patients hospitalized and 
sufficient laboratory work done. 

Case I : 

L. W. Age, 5 yrs. Weight, 60 lbs. 

Chief Complaint: General malaise. 


Present Illness: The patient complained 
of waking up in the morning with a chilly 
feeling and refused his breakfast. His 
mother sent him to school. At noon he re- 
fused his luncheon and complained of general 
malaise. He was put to bed, and when his 
temperature appeared to rise alarmingly a 
doctor was called. 

Past History: Essentially negative. For- 
mal birth. Orange juice and cod-liver oil at 
the prescribed time. 

Physical Examination : Showed a very 

well-developed and well-nourished young 
white male child, flushed, slightly cyanotic, 
and appearing toxic. Temp. 104.0 E. by 
mouth, pulse 150, resp. 32/min. Head, eyes, 
ears, nose, throat, and abdomen were essen- 
tially negative. The rate at the apex was 
very rapid, but there were no cardiac abnor- 
malities. The lungs showed moderate dull- 
ness and increased bronchial breathing over 
the middle lobe of the right lung, also a few 
scattered crackling rales. 

Neurological : Showed positive opisthoto- 
nos, positive bilateral Kernig and Babinski, 
and a questionable positive Gordon. Oph- 
thalmoscopic examination revealed no abnor- 
malities. 

A clinical diagnosis of lobar pneumonia 
with complicating pneumococcic meningitis 
was made and the patient brought to the 
State Street Hospital in Portland. 

Course in Hospital : On admission an im- 
mediate lumbar puncture was done. The 
fluid was under moderately increased pres- 
sure and grossly clear. Cell count was W. B. 
C. 8, R. B. C. 87. The centrifugal sediment 
stained showed the Diplococcus Pneumoniae. 
The globulin was slightly positive (Pandy). 
Culture of the fluid showed pneumonia Type 
IV. W. B. C. on admission was 10,700. The 
urine was essentially negative. No blood cul- 
ture was done. 

Prontylin by mouth was started. Gr. 50 
was given in the first eight hours; gr. 110 in 
the next seventy-two hours. After eight hours 


Volume Thirty, N. 8 


The Pneumococcus and Sulfanilamide 


203 


the temperature dropped to 98.4 F., pulse 94, 
resp. 22/rnin. The temperature never rose 
again beyond 101 F. After an uneventful 
convalescence the patient was discharged in 
fourteen days. W. B. C. dropped to 6,500, 
but rose to 10,500 after the Prontylin was 
discontinued. There was moderate cyanosis 
present during the administration of the 
drug. 

We feel that a large factor in the recovery 
of this case was due to instituting therapy 
very earlv in the disease. 

*J 

Case II: 

A. C. Age, 11 mos. Weight, 16 lbs. 

Chief Complaint : Difficulty in breathing, 
temperature, and cough for three days. 

Present Illness : Patient had whooping- 

cough a few months previous, which left a 
slight cough. Three days ago he vomited and 
his mother thought he also showed signs of a 
slight cold. When it apparently grew much 
worse she brought him to the office. 

Past History: Normal birth, bottle fed, 
had orange juice and cod-liver oil at the 
prescribed time, and dentition normal. 

Family History : Negative. 

Physical Examination : Showed a well- 

developed and well-nourished white male in- 
fant, markedly cyanotic, and apparently 
moribund. Temp. 104.0 F. rectal, pulse ap- 
proximately 170, resp. 72/min. and very 
shallow. Head: Posterior fontanelle closed. 
Anterior fontanelle still open, soft, with no 
gross evidences of increased intracranial pres- 
sure. Eyes, ears, nose, throat, negative. 
Heart : Rate too rapid to detect any abnor- 
mal sounds. Lungs : Marked dullness and 
bronchial breathing over the lower lobes of 
both lungs with coarse, crackling rales. Ab- 
domen: Negative. 

Neurological: Questionable positive Ba- 
binski. No other abnormal signs. A clinical 
diagnosis of bilateral lobar pneumonia, prob- 
ably a fulminating infection, was made and 
the patient brought into the State Street 
Hospital at Portland. 

Course at Hospital : On admission the 


temperature was 103.0 F. rectal, pulse too 
fast to count, resp. 72/min. The W. B. C. 
was 15,100, the urine essentially negative. 
Direct smear from the posterior naso-pharynx 
showed on stained smear and culture a pneu- 
mococcus which did not conform to any of 
the known types on agglutination. 

Prontysil in 5 cc. doses was administered 
every two hours intramuscularly until 75 cc. 
were given. This was accompanied by a 
hypodermoclysis of 100 cc. of normal saline 
every six hours. Eight hours after admission 
the temperature was 105.0 F. rectal, pulse 
too fast to count, resp. 64/min. Twenty-four 
hours later (32 hours after Prontosil was 
started) temperature 99.6 F. rectal, pulse 
155, resp. 40/min. 

45 cc. of Prontosil in 5 cc. doses was given 
intramuscularly in the next 48 hours. The 
temperature varied from normal to 102 F., 
but the peaks were lower each day. The 
patient was markedly cyanotic and the urine 
a very dark red as long as the drug was being- 
given. The W. B. C. remained essentially 
unaffected. 

After an uneventful convalescence the 
baby was discharged home in ten days. 

Conclusions 

Sulfanilamide is a valuable aid in the 
therapy of pneumococcus infections, but only 
if used in sufficient dosage. In these two 
cases, in my opinion, it undoubtedly averted 
a fatal outcome. 

Bibliography 

1. Joseph Millet: N. Y. State Journal , 1938. 

2. Mertins, P. S. & P. S.: Arch. Otolaryngology, 
25:657, June, 1937. 

3. Heinzelman, Hadley, Mellon: Am. Journ. Med. 
Sciences, 193:759, May, 1937. 

4. Caldwell, Byrne: Brit. Med. Journ., 1:1204, 

June 12, 1937. 

5. Joseph Millet: J. A. M. A., 109:2138, Dec. 25, 
1937. 

6. Price, Gordon: J. A. M. A., 112:1021, Mar. 18, 
1939. 

7; Hewell, Mitchell: J. A. M. A., 112:1033, Mar. 
18, 1939. 


204 


The Journal of the Maine Medical Association 


The President’s Page 


To the Members of the Maine Medical Association : 

The 87th Annual Convention at Poland Spring was the largest and perhaps 
the best Convention we have ever held, and much credit is due to those who made 
the arrangements. 

The meetings of the House of Delegates were well attended, although several 
delegates were absent, and the routine business was attended to promptly. 

There was some discussion on the resolution disapproving the Wagner Health 
Act, but the final vote was almost unanimous. 

The Conferences were generally interesting and well attended. 

The Scientific session Monday afternoon in charge of Dr. Gottlieb and Dr. 
Reginald Fitz was remarkably well planned and carried out. The idea deserves to 
he repeated. 

The Tuesday afternoon session was also excellent, with fine addresses by 
President Bunker, Professor Blake of New Haven, Professor Moorhead of New 
York and Dr. Morrison of New York. 

The election of Thomas A. Foster of Portland as President-elect was unani- 
mous, and both Dr. Foster and the Association are to be congratulated. 

Several hundred members and guests attended the final banquet Tuesday 
evening. 

Dr. Morris Fishbein, Editor of the Journal of the American Medical Associa- 
tion, was the principal speaker, and his address was both instructive and highly 
entertaining. 

Fifty-year medals were presented to 

Charles B. Sylvester, Portland, 

Gustav A. Pudor, Portland, 

Bernard A. Bailey, Wiscasset, 

Henry J. Durgin, South Eliot, 

Gilbert M. Elliott, Brunswick. 

It is well worth while for every doctor in the State, who can possibly do so, 
to attend these annual meetings of our Association. 

George E. Pratt. 

President , Maine Medical Association. 


Volume Thirty, No. 8 


Council Maine Medical Association, IQ39-UO 


205 


60UNGIL TvtAINE TvtEDIGAL ASS06IATI0N, 1939-40 



P. L. B. Ebbett 

Ghaicnxan 



Wm. A, ElltngWood 


R. V. N. Bliss 






G. H. Stevens 


Stepki 


en 


A. Gobb 


E. M. McGacty 


206 


The Journal ot the Maine Medical Association 


Editorial 

The Eighty-seventh Annual Meeting 


The eighty-seventh animal meeting can 
and will go down on record as one of the 
most successful in the history of the Maine 
Medical Association. The total registration 
was 466, many of the members were accom- 
panied by their wives and it was the univer- 
sal expression that the scientific and enter- 
tainment program was one of the best ever 
presented to the members. Guest speakers 
from important clinics brought the concensus 
of medical teaching on subjects of daily oc- 
currence and importance which were also 
amplified by the addresses and papers of our 
members. That panel discussions are appre- 
ciated by the members was made manifest by 
the attendance and universal discussions by 
members and guests. Some of the chairmen 
followed a course to be commended ; they 
called personally for opinions on the points 
brought out in the presentation of the panel 
with the result that interest did not lag and 
many additional valuable points were devel- 
oped. It is with pleasure that the most excel- 
lent, facilities, service and cooperation of the 
management of the Poland Spring House are 
acknowledged and which received deserved 
recognition from our president. It is no 
small task to conduct such a service efficiently 
and smoothly. 

The commercial and educational exhibits 
were of exceptional value and quality. That 
their variety and importance were appreci- 
ated is without question since the attendance 
and interest shown must have been gratifying 
to those holding them. These, together with 
several motion pictures, made no small con- 
tribution to medical education. 

Comments on our guest speaker, Dr. 
Morris Fislibein, seem superfluous. After 
a most entertaining preamble he gave a most 
lucid talk on the proposals and activities of 
the Federal Government in regard to organ- 
ized medicine as the story has been unfolded 
to date. The House of Delegates spoke in no 
uncertain terms their opinion in regard to 
the Wagner Bill in the form now before the 
Senate. Copies of this resolution were re- 


leased to the press of Maine and sent to our 
Senators and Representatives in Washing- 
ton. If one thing, however, is important and 
necessary it is that each member of the Maine 
Medical Association regard it as his duty to 
explain to his patients and friends the dan- 
gers and fallacies inherent in this bill and to 
write personal letters of objection to our 
Senators and Congressmen. It was 'with 
pleasure that we also had as a most welcome 
guest the President of the Maine Pharma- 
ceutical Association : Burton Murdock of 

Kennehunk. His message impressed all with 
his sincerity of purpose and his appreciation 
of the task confronting the profession so 
closely allied with medicine. 

What organized medicine faces today in 
way of changes and developments in relation- 
ships and administration of practice no one 
can predicate. That we have in the past 
served our State and our communities with 
one common interest — the health and welfare 
of the people — warrants the confidence that 
the important and vexing problems now be- 
fore us will be met and considered calmly 
but with a progressiveness that is commen- 
surate with the time and need. To protect 
and guarantee the future of medicine, to 
provide the education for and assure the 
quality of physicians who yearly must as- 
sume the places brought by death and retire- 
ment is no small task. It is, however, our 
task for the hour that politicians and bureau- 
crats control in any way the education of the 
physicians of the future medicine as we know 
medicine will cease to exist. 

Tn these unsettled days, not only for medi- 
cine but every other profession and business, 
your officers, committee chairmen and mem- 
bers deserve and undoubtedly will have that 
hearty cooperation that insures for harmony 
and success. Medicine and the allied profes- 
sions of pharmacy and dentistry today, as 
never before, are faced with problems and 
civic responsibilities of the utmost gravity. 
As educated men and women we must bring 
our influence and experience to bear on them. 


Volume Thirty, No. 8 


Program, Maine Hospital Association 


207 


Program 

Maine Hospital Association 

Lakewood, August 30, 1939 

Morning Session 

10.00 A. M. 

Invocation 

Rev. Ludger Ouellette, Pastor Notre Dame Church, Skowhegan 

Report of National Hospital Day Committee 

Helen Goodwin, R. N., Supt., Rumford Community Hospital, Rumford 

Report of Executive Committee 

Pearl R. Fisher, R. N., Supt., Thayer Hospital, Waterville 

Report of Delegate to American Hospital Association 

Stephen S. Brown, M. D., Medical Director, Maine General Hospital, Portland 

Report of Legislative Committee 

Mr. Samuel Stewart, President, Board of Directors, Central Maine General Hospital, Lewiston 

Extension Services — Bingham Associates 

Julius Gottlieb, M. D., F. A. C. P., Pathologist, Central Maine General Hospital. Lewiston 
Discussion by: 

Samuel H. Proger, M. D., Medical Director Joseph H. Pratt Diagnostic Hospital, Boston, 
and member of Bingham Associates 

Joseph H. Pratt, M. D., F. A. C.P., Chief Physician at Joseph H. Pratt Diagnostic Hospital, 
Boston, and member of Bingham Associates 
F. A. Winchenbach, M. D., Director o c Laboratory, Bath Memorial Hospital, Bath 
George Young, M. D., Surgeon at Redington Memorial Hospital, Skowhegan, and Surgical 
Director of Tuberculosis Service at Central Maine General Hospital. Lewiston 

Experience and Progress of the Associated Hospital Service of Maine 
Mr. Paul A. Webb, Executive Director, Associated Hospital Service of Maine 

Address 

Sister Belanger, Sister Superior and Superintendent of St. Mary’s General Hospital, Lewiston 
Address 

Stephen S. Brown, M. D., F. A. C. H. A., Medical Director and Administrator, Maine General Hospital, 
Portland 

12.30 P. M. Luncheon 

Speaker: Frank H. Jackson, M. D., F. A. C. S. ; Editor, The Journal of the 

Maine Medical Association 

Subject: Hospital Publicity 


Afternoon Session 


P U BLI C ReLATIO N S 

Allan Craig, M. D., 


2.00 P. M. 

F. A. C. H. A., Medical Director, Eastern Maine General Hospital, Bangor 


Hospitals and Doctors, or Together for Others 

George Pratt, M. D., Surgeon at Franklin County Memorial Hospital, Farmington, and President of 
Maine Medical Association 


Panel : “Improving the Hospital through Elevation of Professional Standards” 

Frederick T. Hill, M. D.. Chairman. Chairman of Staff, Thayer Hospital, and Chairman of Com- 
mittee on Postgraduate Education, Maine Medical Association 
Carl M. Robinson, M. D., F. A. C. S., and Chief of Surgical Staff, Maine General Hospital. Portland 
Mr. George Otis Smith, President, Board of Directors, Redington Memorial Hospital, Skowhegan; 

Director of Colby College; Trustee, National Geographic Society 
Mr. Richard D. Hall, Director, Thayer Hospital, Waterville 

Joelle C. Hiebert, M. D.. Superintendent, Central Maine General Hospital, Lewiston 
Alice Morse, R. N., Director of School of Nursmg. Eastern Maine General Hospital, Bangor 
Mr. Carroll Perkins, Attorney; Director, Thay:r Hospital 

Report of Dominating Committee 


Report of Resolutions Committee 


208 


The Journal of the Maine Medical Association 


News and Notes 


Joint Meeting 

Kennebec, Penobscot, Piscataquis, 
Somerset 

A joint meeting of the Kennebec, Penobscot, 
Piscataquis and Somerset County Medical Asso- 
ciations was held at Squaw Mountain Inn at 
Greenville, Wednesday, July 19, 1939. 

Allan Woodcock presented a panel discussion of 
Fractures which he had prepared at the request of 
the Maine Medical Association’s Committee on 
Postgraduate Education. Participating in this dis- 
cussion were: 

Carl Corson, Portland — Spine Fractures. 

William V. Cox, Lewiston — Cerebro Spinal In- 
juries. 

Howard Hill, Waterville — Diagnostic Signs as 
Evidenced by Visual Field and Fundus. 

Forrest B. Ames, Bangor — X-ray in Fractures. 

Allan Woodcock, Bangor — General Fracture 
Principles. 

This discussion, which was ably presented, was 
very interesting. 

George L. Pratt, President of the Maine Med- 
ical Association; Frederick R. Carter, Secretary- 
Treasurer; and P. L. B. Ebbett, Chairman of the 
Council, spoke relative to matters pertaining to 
the State Association. 


This meeting, to which the ladies were invited, 
was well attended. 

N. H. Nickerson, Secretary, 

Piscataquis County Medical Association. 

Maine Medical Golf 
T ournament 

The golf tournament for members of the associ- 
ation proved to be a very successful affair. Over 
thirty members entered, and twenty-seven had 
their cards posted. Low gross was won by F. C. 
Tyson of Augusta with a score of 80. Second low 
gross was won by Earl S. Merrill of Bangor with 
an 86. Third low gross resulted in a half at 88 be- 
tween C. C. Weymouth of Farmington and W. R. 
McAdams of Portland. The draw was won by 
W. R. McAdams. 

The kickers’ handicap resulted in a triple tie at 
75 strokes net. The winner of the draw was Carl 
E. Richards of Alfred. Second, Frank H. Jackson 
of Houlton. Third, John H. Moulton of Rangeley. 
Suitable prizes were awarded to the winners of 
each group. 

It is gratifying to know that physicians are 
interested in suitable recreation for themselves. It 
is to be hoped that an even greater number will 
enter the golf tournament during the annual meet- 
ing next year. 


Annual Meeting Maine Medico-Legal Society 


The annual meeting of the Maine Medico- 
Legal Society was held at Poland Spring 
Tuesday, June 27th, with the President, 
Oscar F. Larsen, presiding. 

Attorney-General Burkett and Senator H. 
C. Marden and others discussed the change in 
the Medical Examiner Law that goes into 
etfect January 1 , 1941. 

Senator Marden, Representative Peter 
Mills, and Attorney Benjamin Butler, were 
elected as honorary members. 


It was voted that a committee be appointed 
by the President to include the Attorney- 
General, and to report at the next annual 
meeting on what should be our attitude on 
the situation in 1941. 

Officers elected for 1939-1940 were: 

President — Walter S. Stinchfield. 

Vice-President — Franz IT. Burkett. 

T reasurer — Willi am Holt. 

Secretary — George L. Pratt. 

George L. Pratt, Secretary. 


Volume Thirty, No. 8 


Necrology 


209 


Necrology 



Thomas S. Dickison, M. D., 
1868-1939 


Born March 10, 1868, in Kirkland, New Bruns- 
wick, Doctor Dickison obtained his preliminary 
education in the Woodstock High School, gradu- 
ated from the University of New Brunswick in 
1890, and obtained the degree of M. D. from 
Bellevue Medical School in 1893 in which year he 
came to Houlton where he remained the rest of his 
life. 

When Doctor Dickison commenced practice in 
Houlton there was no hospital north or east of 
Bangor, even the services of graduate nurses were 
rarely available and the surgery of his section and 
all of Aroostook was done in private homes and 
with assistance that today would be regarded as 
most inadequate. Undaunted by such difficulties, 
having a great interest in surgery and an aptitude 
for the work, he studied with care and thorough- 
ness the available surgical literature and slowly 
step by step, forced by the times and conditions to 
learn many things by trial and error, he became in 
the years a safe and capable surgeon. 

Impressed with the great need of a hospital in 
Houlton he built the Aroostook Hospital which 
was opened in 1906, to which for the remainder of 
his life he devoted a great deal of time and per- 
sonal attention, and which became a corporation in 
1910 composed of the physicians of Houlton and 
surrounding territory until 1938 when it was again 


incorporated as a non-profit organization. Early 
in its career and formation the hospital met with 
opposition from some who evidently were unable 
to appreciate the value of a community hospital to 
the community and the profession it served. Such 
an attitude bothered him little, if at all, and the 
results bear full well the strength of his soundness 
of view. 

The last few years of his life, burdened by ex- 
treme sorrow and illness, he bore with stoicism 
and commendable fortitude. He carried on uncom- 
plainingly to the end, but spent the last two or 
three years quietly with friends but always main- 
taining an active interest in the hospital and asso- 
ciated professional life. Always active in and 
interested in medical activities he served as presi- 
dent of the Aroostook County Society in 1920 and 
for many years was a faithful and interested at- 
tendant at the annual meetings of the Maine Medi- 
cal Association. From the inception of the surgi- 
cal service on the Bangor & Aroostook Railroad he 
was the local surgeon. 

He is survived by his widow, Almatia Nelson, 
whom he married in 1895, and one daughter: Mrs. 
Jean Thalheimer. Doctor Dickison will be greatly 
missed in the community he served so long and 
well. 


2/0 


The Journal of the Maine Medical Association 


Notices 


Venereal Disease Clinics 

For the information of physicians wishing to 
refer cases of venereal disease for treatment, the 
State Bureau of Health announces that such facili- 
ties are available in the following locations: 

Augusta, Bangor, Bath, Belfast, Biddeford, Bing- 
ham, Calais, Danforth, Eastport, Ellsworth, Grand 
Isle, Guilford, Houlton, Island Falls, Lewiston, 
Millinocket, Old Town, Portland, Presque Isle, 
Rockland, Rumford, Sanford, Waterville, Wilton, 
Winthrop. 

Any physician wishing to refer a case may 
obtain the name of the clinic physician, in the 
town where the patient is to receive treatment, on 
request to the Director, State Bureau of Health, 
Augusta, Maine. 


Lewiston: Central Maine General Hospital — 

9.00 to 11.00 A. M., Saturday, Aug- 
ust 26th, September 30th, Octo- 
ber 28th. 

Machias: Normal School — 1.00 to 3.00 P. M., 

Wednesday, October 18th. 

Portland: Children's Hospital — 9.00 to 11.00 

A. M., 1.00 to 3.00 P. M., Monday, 
August 14th, September 11th, Oc- 
tober 9th. 


Presque: Isle : Northern Maine Sanitarium — 9.00 
to 11.00 A. M„ 1.00 to 3.00 P. M., 
August 30th, October 24th. 


Bureau of Health 
Services for Crippled Children 
Clinic Schedule 

Bangor: Eastern Maine General Hospital — 

1.00 to 3.00 P. M., Thursday, Aug- 
ust 17th, September 21st, October 
19th. 

Fort Kent: Normal School — 9.00 to 11.00 A. M., 

1.00 to 3.00 P. M., Tuesday, Aug- 
ust 29th. 


Rockland: Knox County Hospital — 1.30 to 3.00 

P. M., Thursday, September 7th. 

Rumford: Rumford Community Hospital — 1.30 

to 3.00 P. M., Wednesday, Septem- 
ber 27tli. 

Waterville: Thayer Hospital — 1.30 to 3.00 P. M.,. 

Thursday, September 28th. 

N. B.: This clinic schedule is subject to change. 
If changes are necessary, adequate notice will be 
given. 


A. M. A. Indictment Quashed! 


Justice James M. Proctor, upholding a defense 
demurrer to indictments, ruled on July 26th that 
the American Medical Association and its fellow 
defendants were not engaged in a trade as defined 
by the antimonopoly statutes. Counsel for the 
doctors had contended their activities could not be 
governed by the Antitrust Law, that they were 
engaged in a “learned profession” rather than a 
trade. On December 20, 1938, a District of Colum- 
bia Grand Jury, acting on evidence presented by 
the Justice Department, indicted the American 
Medical Association, the Medical Society of the 
District of Columbia, the Washington Academy of 
Surgery, the Harris County (Texas) Medical 
Society and twenty-one individual physicians for 
violation of the Sherman Antitrust Law. These 
organizations and individuals, the indictment read, 
were “engaged in a continuing combination in 
conspiracy in restraint” of trade in hampering the 
activities of Group Health Association, Inc., for 
the District of Columbia, a organization estab- 
lished in 1937 to hire physicians and nurses and 


provide hospital care on a cooperative basis to 
government employees. Defense attorneys had 
contended that all their clients’ activities were 
directed solely at the maintenance of the ethics 
and standards of the profession. 

At the headquarters of the Association, officials, 
including Dr. Olin West, Secretary, and Dr. Morris 
Fishbein, Editor, said: 

“The principles and policies of the American 
Medical Association do not forbid nor have 
they ever contemplated any opposition to a 
well considered, expanded program of medical 
service, when the need can be established; 
neither is there any fundamental principle or 
policy which in any manner opposes aid to the 
indigent when indigence can be established. 

“The American Medical Association has 
always welcomed investigation by any author- 
ized agency of the nature of its organization 
or of the conduct of its work or of its activities, 
firmly reliant in the belief that every action 


Volume Thirty, No. 8 


Book Reviews 


211 


taken by the Association has been in accord- 
ance with its constitutional organization in 
the interests of the public welfare for advanc- 
ing standards and quality of medical service 
for the American people; and that at no time 
has it violated the established law of the 


federal, state, or municipal governments of 
this country. Moreover, by the very nature of 
its organization, it has preserved constantly 
the democratic principles on which the Gov- 
ernment of the United States is founded and 
maintained.” 


Book Reviews 


“A Textbook of Surgery ” 

(Second Edition) 

By American Authors. 

Edited by Frederick Christopher, B. S., M. D., 
F. A. C. S., Associate Professor of Surgery at North- 
western University Medical School; Chief Sur- 
geon, Evanston (Illinois) Hospital. 

Published by W. B. Saunders Company, Phila- 
delphia and London, 1939. Cloth, $10.00 net. 

Christopher’s Surgery is a most excellent ex- 
ample of cooperative teamwork of many of 
America’s well known teachers of medicine and 
surgery. 188 authors collaborated in the produc- 
tion of this monumental one-volume text of 1695 
pages, with 1381 illustrations on 752 figures. Almost 


all of the surgical features included in everyday 
medical practice, with their many ramifications, 
are concisely, clearly and instructively described 
for the benefit of the medical student and the 
general practitioner. In the present edition many 
of the articles have been revised, rewritten, en- 
larged or contracted where permissible, and some 
new ones have been added, such as: cancer of the 
lip and tongue; congenital obstruction of bile 
ducts; duplication of alimentary tract; lympho- 
granuloma inguinale, tetanus and anorectal afflic- 
tions of various kinds. The various uses of sul- 
fanilamide have been described by twelve authors. 
All articles are of sufficient clarity in their descrip- 
tion of definition, etiology, pathology, symptoms, 
diagnosis, prognosis, treatment, postoperative care, 



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2/2 


The Journal of the Maine Medical Association 


etc., to provide correct guidance for the physician, 
and the illustrations and descriptions of the sur- 
gical techniques are sufficiently detailed to permit 
the physician-surgeon to see his case through from 
beginning to end in most of the usually occurring 
emergencies. Even though both general surgery 
as well as the surgical specialties are magnificently 
represented, no section of the book shows a ten- 
dency to displace the specializing and highly 
skilled operator. All of the authors present their 
teachings for the purpose of attainment of better 
surgical results by their readers. A masterful com- 
bination of masterful teaching for a masterful 
medical-surgical service to mankind. 


“ Standard Body parts Adjustment Guide — 
Traumatic Injuries, Medical Fees, 
Evaluation” 

Published by Insurance Statistical Service of 
North America, Chicago, 111., 1939. Price, $8.00. 

Even though this work was conceived by and 
created for the insurance interests, especially for 
the benefit of the compensation adjuster, it is 
admirably adaptable to the needs of the practicing 
physician. The language is essentially nontech- 
nical, but the anatomical charts are indexed in the 
Latin and English terminology. Among the most 
important features of the book are: description 

of the body and its functions; medical fees, based 
on averages obtained in a coast-to-coast survey; 
specialists’ fees; estimates of periods of disability 
and unemployability in traumatic and occupational 
diseases; technique of evaluation; digest of state 
provisions for compensation; and a medical ter- 
minology. 

The work is hoped to supply a timely universal 
need of the medical, medico-legal and insurance 
professions. It would seem that every practicing 
physician who is likely to engage in any kind of 
compensation work would like to own this guide 
to be consulted whenever adjustment problems 
arise. The purchase price includes ten years of 
revision service. 


“ The Physiology of Exercise — A Textbook 

for Students of Physical Education” 

By James Huff McCurdy, A. M„ M. D„ M. P. E„ 
Director of Physical Education, Springfield College, 


Springfield, Mass., etc.; and Leonard A. Larson, 
B. A., B. P. E., M. Ed., Ph. D., Professor of Health 
and Physical Education, Springfield College, Spring- 
field, Mass. Third edition, thoroughly revised. 
Published by Lea & Febiger, Philadelphia, 1939. 
Price, $3.75. 

This thoroughly revised and considerably en- 
larged edition presents two new additions. One is 
a section on exercise for women, and the other a 
chapter on exercise for people over forty years of 
age. The working plan of this excellent work 
apparently is built up on the conclusions that 
“physical exercise is related to physical efficiency. 
The present civilization is making great demands 
upon the vitality of the race. School practices 
which train simply eye, ear, tongue and hand do 
not promote the health of the pupils. Laboratory 
work, shop work, military drill and domestic 
duties increase only slightly the big muscle activ- 
ity. The active use of the big muscles is essential 
to the health of individuals. These activities are 
not secured in the home, on the street, or in ordi- 
nary business. Big muscles activities are essential 
to the development of vocational and other kinds 
of skill. The higher levels of the nervous system 
depend for their health and stability upon the 
organic development of the middle and lower levels 
of the nervous system. Big muscle activity in 
physical recreation is an essential part of emotional 
control in relation to the formation of character.” 

The book in its present make-up seems to be very 
complete, and it would no doubt be good judgment 
on the part of every physician, who is in any way 
interested in the problem of physical exercise, to 
consult McCurdy and Larson for further informa- 
tion on the subject, either directly through the 
text or indirectly through the very extensive bibli- 
ography which is attached to each of the fifteen 
chapters. The employment of stimulative and seda- 
tive drugs during training is almost universally 
condemned where best results are desired. 


“ What It Means To Be a Doctor” 

By Dwight Anderson. Published by The Public 
Relations Bureau, Medical Society of the State of 
New York, 2 East 103rd Street, New York City, 
1939. Price, $1.00. 

This pleasingly written little book tells in the 
form of a modern doctor’s life story some of the 



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usual experiences which everyone who enters the 
field of medicine expects and hopes to live through. 
The doctor is followed from his childhood through 
his boyhood, his years in college, medical school, 
hospital training and practice. It describes in illus- 
trative language the principal steps in the develop- 
ment of the successful physician and surgeon. 

If this booklet could be placed in the hands of 
every boy who is desirous of entering the field of 
medicine as his life work, a great many errors of 
thinking would not develop, and consequently no 
effort would later have to he expended in the cor- 
rection of such errors. Medicine has always been 
and must always remain a service given by one 
person to another person, and the type of service 
can and will be perfected through perfection of 
educational facilities, the propagation of perfected 
knowledge, and the selection of specially qualified 
men to meet the requirements of the present and 
the anticipated demands of the future. 


“A Manual of Fractures and 
Dislocations ” 

By Barbara Bartlett Stimson, A. B.. M. D.. Med. 
Sc. D., F. A. C. S. Associate in Surgery in the Col- 
lege of Physicians and Surgeons, Columbia Uni- 
versity. New York City; Assistant Attending Sur- 
geon to the Presbytarian Hospital. New York City. 
Illustrated with 95 engravings. Published by Lea 
& Febiger, Philadelphia, 1939. Price, $2.75. 

This is a handy pocket-sized, flexible cover 
manual on fractures and dislocations for the use 
of medical students and general practitioners. The 
author has tried to present the problem of appro- 
priate treatment clearly and practicably with a 
view to satisfactory anatomic, economic, psycho- 
logic and sociologic re-adjustment. The book 
should receive favorable comment and ought to 
become a useful consultant to all those who have 
to treat fractured bones and injuries associated 
with fracture accidents. The proper technic of 
treatment and approximate length of immobiliza- 
tion for best results is given for nearly every 
form of injury. 


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The Journal 


of the 

Maine Medical Association 


Uolume Thirty Portland, Ulaine, September, 1939 


No. 9 


Hip Nailing * 

By Gordon Mackay Morrison, M. D., F. A. C. S., Boston, Massachusetts 


Hip Nailing has been done for years by 
open operation. A large incision — much 
shock — used only on selected cases which had 
to be unusually sturdy and tough to survive. 

Many elderly persons were “sandbagged” 
—suffered continued pain for days; there 
was high mortality from pneumonia, bed 
sores and subsequent infection. 

Statistics 

Prior to “blind” hip nailing for intracap- 
sular fractures of the neck of the femur, the 
mortality was high — 25 to 30% — and bone 
union was low 25 to 35%. 

Today, with careful and precise reduction 
and nailing — mortality has dropped to below 
10% and bone union has risen to 75 to 80%. 
Some report higher percentages of good end 
results. 

Indications 

All intracapsular neck fractures should be 
nailed, unless the patient is actually mori- 
bund. Hip nailing is the only method bv 
which decrepit elderly persons, may with 
comfort, be put into a chair the day after the 


operation. In these people over 80. they may 
be helped onto their feet and aided to walk 
the day after operation. With proper tech- 
nique, minimal doses of spinal anesthesia, 
properly regulated, the writer has operated 
patients as old as 90, and had one fatality on 
the table out of a series of 101 cases. That 
one fatality was a known cardiac, and not a 
spinal death. 

Considering that small group of patients 
over 80, who walked the day after operation, 
each got a better bony union than those 
treated conservatively, and they got it sooner. 

This seems at first thought to be radical 
treatment, and to show poor judgment- — but 
when one follows such a group — even though 
small — one is impressed with the possibilities 
presented. 

Methods 

Any method that is done with precision 
and skill, is a good method of hip nailing. 
Whether one uses the excellent triangular 
nail of Smith-Peterson, or the other methods 
of internal fixation, matters little — provided 
the operator knows his job, and does it ex- 


* Read at the 87th Annual Session of the Maine Medical Association, Poland Spring, Maine, June 27, 


1939. 


2/4 


The Journal of the Maine Medical Association 


actly. It lias been our custom to wait about 
four clays for recovery from shock and ileus 
which so often result. Skin traction during 
this interim prevents overriding and further 
capsular tear. 

Simplicity of technique should be sought 
in this operation. Spinal anesthesia is prefer- 
able to ether or local because it gives the 
maximum relaxation for manipulation and 
reduction. The use of the fluoroscope on a 
large number of operated cases of any kind 
is dangerous to the operator. 

A table permeable to X-rays, with a tunnel 
in it to place the film, without disturbing the 
patient is very helpful. The antero-posterior 
views are then taken. In order to get the 
lateral views some men prefer the “frog” 
position of flexing the thigh and outwardly 
rotating the leg. This method, it seems to the 
writer, allows motion at the fracture site — 
before adequate internal fixation has been ac- 
complished. It would appear safer to have a 
film placed in the groin, — the good hip flexed 
to make room for the film — the machine 
properly aimed and at the proper height. Or, 
the reverse may be clone — the tube placed in 
the groin — the film held behind the point of 
the iliac spine. The film is held so as to be 
flat facing the rays. With the filming as out- 
lined — the procedure is simplified. One nat- 
urally has preoperative X-rays before the day 
of operation. 

Manipulation and reduction is done — the 
leg held in marked internal rotation, and 
some abduction. Artificial impaction into 
valgus is carried out, and X-rays taken with- 
out disturbing the fractured leg. Films will 
show whether or not the reduction is satis- 
factory. The lateral view will demonstrate 
how the neck of the femur lies with relation 
to the table, the most important single factor 
in the actual nailing. 

Too little internal rotation of the leg will 
require the entering wires or nails to climb — 
the neck slopes upward. Too much internal 
rotation will make it necessary for the wire to 
dive posteriorly — for again the neck is not 
parallel to the table. 

This in itself matters not — so long as the 
leg is held absolutely still without the slight- 
est degree of movement in rotation, after the 
lateral view lias been taken. Any inattention 
on the part of the assistant holding the leg, 


will throw the operator off aim, and he will 
place his wire or nail too far posteriorly or 
too far anteriorly — probably causing him to 
miss the head entirely. 

Skin preparation and draping is carried 
out. 

A 3-4" incision on the lateral surface of 
the leg below the trochanter, dividing fascia, 
is an important step, because a nail driven 
through the fascia lata, pinning it to the 
femur, may be pulled out prematurely by the 
outward tugging of fascia which is offset by 
the trochanter. 

Finding a point about 1" to lbfi" below 
the lower end of the trochanter — a 5 14" drill 
may be put into the shaft, up through the 
neck into the head. A second drill may be 
driven parallel to this — and check films may 
then be taken, A P and Lateral for position. 
If satisfactory, one drill tip is removed and 
there is still the remaining one to use as a 
directional guide for one of two or three 
stainless steel nails to be introduced. Gener- 
al lv two nails will be sufficient for strength, 
and they prevent rotation of the head on the 
neck. 

There are many “directional finders” on 
the market — but they are not necessary if 
this simple technique is used. 

After the nails are inserted and pounded 
into position with a nail set — reimpaction 
should be done, since rather frequently some 
distraction occurs. 

It is our custom at this point to again 
check position of nails, and then to suture 
the divided fascia behind the nails. 

A 314" nail is usually satisfactory in 
length. Before closing the wound, careful 
hemostasis should be accomplished — and the 
subcutaneous layers sutured loosely as well 
as the skin itself — to avoid hematomas. A 
dry sterile dressing and plenty of adhesive 
plaster completes the procedure. 

On the day after operation it is our cus- 
tom to lift the patient into a chair, and to in- 
stitute active exercises of hip flexion and 
straight leg raising. Two complications to be 
avoided are abduction contracture and knee 
flexion. These are easily prevented by ab- 
duction of the leg actively while lying in bed 
once or twice a day — and by seeing to it that 
the knee is straightened completely several 
times daily. 


Volume Thirty, No. 9 


Nip Nailing 


215 


When should the average case walk ? 

This is a controversial question, and one 
that rarely fails to stimulate discussion — 
sometimes heated. 

It has been our experience that in patients 
over 80 years of age it is a good practice from 
a systemic medical point of view — to get 
them up walking the next day after opera- 
tion. If there is sufficient cooperative ability 
to walk with crutches — it is advisable to start 
out that way. If senility interferes with 
balance on crutches — then walking on the 
arm of an attendant is begun. Particularly 
in the cases of old men with prostatic diffi- 
culty, immediate early walking protects 
against serious trouble. 

In those patients who have a life expect- 
ancy of a number of years— we have been 
more conservative ; starting active exercises 
as described, the day after operation, but not 
allowing weight bearing for months — until 
X-ray films show sufficient repair to warrant 
weight bearing’. Enless the nails have be- 
come loose and painful we have not taken 
them out. 


Another factor worthy of consideration is 
that in a number of our patients — 65 to 70 
years of age, who have been restricted for six 
or more months from weight bearing, they 
have shown some degree of cystic degenera- 
tion in the head of the femur along the 
superior articulating surface of that part— 
evidently as a result of too sudden strain 
after absence of weight bearing for six 
months or more. 

Therefore, it is probably wise to begin very 
slight weight bearing over a period of many 
weeks — in those patients who are not so old 
as to warrant walking the day after operation. 

Conclusions 

1. Xailing enables elderly patients to be 
up in a chair and walking on crutches within 
a day or two. 

2. It shortens hospital stay to a week or 
ten days, and is of great economic advantage. 

3. It lessens mortality and increases bone 
union. 


Tuberculosis Heaths Among Young 
A omen. The excess of deaths from tubercu- 
losis among young women over that of males 
of the same age has long been regarded as an 
enigma by the medical profession. In an 
exhaustive study made in Xew A r ork and 
Detroit, everv death during one vear from 
tuberculosis among young women was care- 
fully investigated and several facts emerged 
from an analysis of the material obtained. 

School life, race, nativity, participation in 
industrial life, insufficient clothing, poor 
food habits, including the ever-present diet- 
ing fads, lack of sleep and too much recrea- 
tion seem negligible in their influence. The 
real hazard is the psychic and physical 
changes attendant upon adolescence and ma- 
turity. Early marriage and child-bearing 
increase the death rate from tuberculosis in 
this group. — Xicholson, E., Stud)/ of Tidier. 
Among Young Women , N. T. A. Social Re- 
search Series , Xo. 7. 


Recovery from Tuberculosis. Much has 
been said and written of late years as to the 
relative value of the early diagnosis of pul- 
monary tuberculosis, but it is no less impor- 
tant to be sure by reliable tests that the 
disease is arrested. Temperature, pulse-rate, 
blood sedimentation and X-rays should all be 
utilized in coming to a decision and after 
there is no further progression, time should 
be given for the healing of the existing patho- 
logical process. Only then can the patient be 
assured that recovery has taken place and 
that recurrence is unlikely under the ordi- 
nary stresses of life. — Green, J. W., Med. 
Bull. Yet. Adm., Tan., 1936. 


On one point there is no longer debate. 
The need of medical and social supervision 
for arrested cases of tuberculosis over a pro- 
longed period is clearly indicated. It is the 
only insurance against failure regardless of 
whatever procedure is adopted in the indi- 
vidual case . — Nafl Tuber. Assn Ann l Rep., 
1938, 


21 6 


The Journal ol the Maine Medical Association 


Traumatic Shock* 


By Franklin G. Balcii, Jr., 

In this paper I shall not present to you any 
new or original work on traumatic shock. I 
shall try, however, to give you the present 
conception of shock and the best form of 
therapy. 

Shock can be divided into two types, pri- 
mary and secondary. The primary type is 
essentially one of collapse coming on sud- 
denly as after a severe blow. It is not this 
type with which we are concerned. I think 
all of you are familiar with the patient show- 
ing secondary shock. His skin is cold, clam- 
my and dusky ; his pulse thin, thready and 
rapid ; his respirations shallow, feeble and 
frequently interrupted by sighs. Thirst is 
often present but frequently associated with 
nausea. The outstanding feature is a blood 
pressure 75 mm. Hg. or below. The mind is 
frequently clear. This picture may present 
itself after small or large hemorrhages or 
after moderate or severe injuries. It does not 
occur immediately but is a later manifesta- 
tion. 

Laboratory studies show that these patients 
have a lowered metabolism, a high hemo- 
globin reading, an increase in blood sugar and 
KPN with a decrease in blood chlorides and 
C0 2 combining power. 

Theories As To Low Blood Pressure 

Cannon 1 states that “three factors may be 
concerned : 

(1) Weakened vigor of the heart. 

(2) A lessening of vasomotor tone so that 
the capacity of the vascular system 
is greater than its content and the 
blood is, therefore, not held under 
normal tension. 

(3) The obverse of this, a reduction of 
blood volume below the minimal ca- 
pacity of the vascular system so that 
again the capacity is greater than 
the content.” 

Let us look into these causes in greater 
detail. 

(1) Weakened cardiac vigor. No experi- 
* Read at the 87th Annual Session of the Maine 


M. D., Boston, Massachusetts 

mental evidence has been brought forward to 
prove that the cardiac action is impaired 1 . 
There is, therefore, very little value in the 
use of cardiac stimulants. Digitalis is of no 
value. Epinephrin is in fact contraindicated 
due to its constricting action on the arteri- 
oles. Caffeine may be of slight value. 

(2) Lessened vasomotor tone. Cannon 3 
states that “there are numerous observations, 
also, which prove that in the early stages of 
shock, when the blood pressure is falling, the 
peripheral vessels are constricted instead of 
being relaxed.” He adds that in prolonged 
instances of relative anemia, the venous cells 
may be damaged which, of course, will cause 
an eventual loss of vasomotor tone. 

(3) Reduced blood volume. Most observ- 
ers agree that this is the important factor in a 
lowered blood pressure but there is no unani- 
mous agreement as to why this occurs. All 
agree, however, that hemorrhage will reduce 
the blood volume which, of course, explains 
why the symptoms of shock and hemorrhage 
are so closely alike. 

Keith', during the World War, showed 
that the volume of circulating blood might be 
lowered from 15% to 50% in shock. If it 
were lowered more than 35%, the prognosis 
was very grave. 

Cannon 1 in 1923 advanced the theory that 
some toxic substance having a histamine-like 
action was liberated from the wound. This 
has not been demonstrated by Smith 4 , and 
Parsons' 1 and Phemister. Blalock 1 ' et al have 
also disagreed with this toxic theory. He be- 
lieves that a loss of blood into the adjacent tis- 
sues is an important factor. O’Shaugnessy 7 
from his experimental work feels that “a 
toxemia due to the elaboration of histamine 
plays no part in the syndrome of traumatic 
shock.” He believes that “too little attention 
has been paid to the nervous side,” advo- 
cating the use of spinal anesthesia. Fear, 
pain, cold, all favor the production of shock. 
Cannon, Freeman 8 and others have shown 
that prolonged sympatho-adrenal hvperactiv- 

Medical Association, Poland Spring, Maine, June 27, 


1939. 


Volume Thirty, No. 9 


Traumatic Shock 


217 


itv may lessen the quantity of circulatory 
blood. By what means this is brought about 
is somewhat uncertain. 

Coonse 11 and his co-workers have done con- 
siderable experimental and clinical research 
concluding that shock from acute hemorrhage 
and shock from trauma or slow hemorrhage 
differ essentially. In the former no acidosis 
exists while in the latter it is an important 
factor. They believe that “not only is there a 
loss of circulatory blood volume, but that the 
acid base balance undergoes a striking change 
toward the acid side.” They believe that with 
loss of tone there is increasing anoxemia 
which in turn damages the vessels allowing 
the escape of essential salts and protein. 

From this short resume as to the causes of 
shock, you have undoubtedly come to the con- 
clusion that, there is no one single cause of 
shock. Be it due to toxemia, lessened vaso- 
motor tone, reduced blood volume or in- 
creased psychic stimuli, the one outstanding 
feature is a lowered blood pressue. 

Prevention 

Let us now turn our attention to what can 
be done to prevent shock. We are particular- 
ly interested in that type following accidents 
associated with fracture. It was dramatically 
demonstrated that a marked drop in mortal- 
ity occurred during the World War following 
the use of the Thomas and Jones splints. 
These with slight modifications are of just as 
much value today as they were some twenty 
odd years ago. xVll hospitals and first aid sta- 
tions should be equipped with these. More- 
over, any doctor called upon to do much trau- 
matic work should carry with him a leg and 
arm splint. These have been rather expen- 
sive in the past, costing about $10 to $15 a 
pair. It is hoped, however, that a set can be 
made minus any frills selling for between $6 
and $8 a pair. It is needless to say that an 
adequate control of hemorrhage is essential 
as a preventive. 

Treatment 

The replacement of lost blood volume is the 
most urgent requirement. Blood transfusion 
is the most satisfactory medium. In its ab- 
sence 1000 c.c. of 10% glucose in saline may 
be employed intravenously at the rate of 1 to 
10 c.c. per minute. This is but of transient 
use as it rapidly diffuses from the blood ves- 


sels. If continued, this may wash out some 
of the plasma from the blood. This solution 
is put up in sterile flasks by several drug 
houses and is available for emergency use in 
the office or home. 

Coonse has advocated the use of sodium 
bicarbonate in 5% strength to combat acido- 
sis and has reported very gratifying results 
both experimentally and clinically. He does 
not believe that inhalation of C0 2 is effective. 

Morphia in adequate dosages is effective if 
given early in delaying or minimizing the 
further progression of shock by lessening 
painful stimuli. It should not, however, be 
used in advanced cases where it will lower 
the vitality of centers already markedly de- 
pressed. 

Heat is a very valuable method of treat- 
ment. It serves a dual purpose, (1) by pre- 
venting further loss of heat from the stag- 
nant peripheral circulation, (2) by improving 
the normal physiological processes dependent 
on an adequate temperature. The Massachu- 
setts General Hospital has a special table 
heated by water with a mechanism for lower- 
ing the head. All patients in shock or sus- 
pected of shock are placed on this table. 

Several years ago there was a good deal of 
enthusiasm concerning gum acacia as a sub- 
stitute for blood. During the World War this 
was advocated in the treatment of shock as it 
would remain in the blood stream. Due to 
impurities, however, there were many fatali- 
ties so that its use fell into disrepute. There 
have been reports of its successful use with 
the more pure forms. Huff am reported its 
use in 3,000 infusions at the Mayo Clinic 
between 1926 and 1932 with one unfavorable 
result. This was a 6% solution in normal 
saline. Andersch" and Gibson of the Univer- 
sity of Iowa showed in animals that 30% to 
50% was deposited in the liver with a dimin- 
ished output of bile salts and bilirubin. More 
recently Studiford 1 " has reported on its use 
on the obstetrical and gynecological service 
at the Bellevue Hospital in Hew York. He 
reports several cases characterized “by cya- 
nosis, dyspnea, tachycardia and pulmonary 
edema.” In two autopsies the liver was prac- 
tically destroyed. He employed 6% acacia 
in 20% glucose. It has been used occasion- 
ally at the Massachusetts General Hospital 
and the Boston City Hospital. As far as I 
have been able to determine, it has not been 


218 


The Journal of the Maine Medical Association 


used at the latter institution during the last 
few years and only once at the former during 
the past year. This was for a severe hemor- 
rhage when no immediate donor was avail- 
able. It has also been shown that acacia 
increases the resistance of red cells to hemo- 
lyzing agents, reduces the oxygen carrying 
capacity and increases rouleaux formation. 

From this discussion you will conclude 
that gum acacia in 6% solution in saline is 
of use in an emergency when blood is not 
available. Otherwise, it should not be used in 
the treatment of shock. 

Transfusion 

Blood transfusion is agreed by all to be the 
best method of combating shock. This not 
only increases the fluid volume but also in- 
creases the oxygen carrying capacity of the 
blood stream. Above all it will not permeate 
through the blood vessels. Formerly we gave 
this by the whole blood method using the Vin- 
cent or Kimpton paraffin tubes. This method 
has been abandoned for the use of citrated 
blood which is a far simpler technique and 
can be carried on with the minimum of wor- 
ry, hurry and equipment. At the Faulkner 
Hospital practically all of these are given by 
the House staff. Recently one of the drug 
houses has come out with a flask of citrate 
which contains enough vacuum to draw in 
500 c.c. blood. We have had no experience 
with this but it should be quite ideal. Lundy 1 ' 
reports 3,295 citrate transfusions from the 
Mayo Clinic in 1938 in most instances using 
groupings only. He reports fairly severe re- 
actions in 4.0% of cases. 

A few suggestions as to technique may be 
not amiss at this point. 

(1) Cross matching. We believe that the 
donor and recipient should be grouped and 
in addition to this, that the donor’s cells 
should be directly matched with the recipi- 
ent’s serum, Hanging drop preparations 
should be used, not cover glasses on a flat 
slide. This should be observed if possible 
about 45 minutes. 

(2) Diet of donor. Transfusion should 
not be done immediately after the donor has 
had a meal as it is thought that some reac- 
tions may be due to protein sensitivity. 

(3) Wassermann test. This, of course, 
should be done on all donors. 


(4) Refrigerated blood. We are accus- 
tomed to using the blood immediately. Lun- 
dy reports that in 1938 “40.7% of ail trans- 
fusions refrigerated blood was used and in 
59.3%, fresh blood.” He states that reactions 
were a little less frequent with refrigerated 
than with fresh blood. 

(5) Blood banks and cadaver blood. We 
have had no experience with this technique. 
They have been reported as being successful. 

Whatever the cause of secondary shock and 
whatever form of therapy we employ, let it 
be employed soon enough. Don’t wait until 
the blood pressure has “dropped out of 
sight.” Start therapy when it is around 90, 
not when it is 60. 


Summary and Conclusions 

(1) The cause of shock is not known. 

There are probably several. The following 

theories have been advanced: 

(a) Toxemia. 

(b) Decreased vasomotor tone. 

(c) Reduction of blood volume. 

(d) Acidosis. 

(2) It may be prevented by 

(a) Proper use of splints for frac- 
tures. 

(b) Proper use of heat and mor- 
phia. 

(3) It is best treated by 

(a) Transfusion. 

(b) Intravenous fluids such as 
10% glucose in saline or 5% 
sodium bicarbonate. 

(c) 6% gum acacia in saline. 

Bibliography : 

1. Cannon, W. B.: Traumatic Shock, New York, 
1923. 

2. Keith, N.: Rep. Shock Com. Med. Res. Com., 
No. 27, 1919. 

3. Cannon, W. B.: Trans. Am. Surg. Assn., LII: 
123, 1934. 

4. Smith, M. I.: Jour. Pharm. and Exp. Therap., 
32:465, 1928. 

5. Parsons, E., and Phemister, D. B. : S. G. O., 

51:196, 1930. 

6. Blalock, A., Beard, J. W., Johnson, G. S.: J. 
A. M. A., 69:1794, 1931. 

7. O’Shaugnessy, L., and Slone, D.: Brit. J. 

Surg., 22:589, 1934. 

8. Freeman, N.: Am. Jour. Physiol., 403:185, 

1933. 

9. Andersch, M., and Gibson, R. B.: J. Pharma- 
col. and Exp. Therap., 52:390, 1934. 

10. Studiford, W. E.: S. G. O., 64:772, 1937. 

11. Coonse, G. K., Foisie, P. S„ Robertson, H. E., 
and Aufrane, O. E.: N. E. J. M., 212:647, 1935. 

12. Lundy, J. S.: Proc. Staff Meetings Mayo Clin- 
ic, 18:273, 1939. 


Volume Thirty, No. 9 


Anesthesia for Traumatic Surgery 


21 9 


Anesthesia for Traumatic Surgery* 

By Dr. Sidney Cushing Wiggin,! Boston, Massachusetts 


Much has been written about anesthesia 
for the surgical patient in elective surgery, 
but little has been said about the care of the 
traumatic surgical patient. Traumatic sur- 
gery is that branch of surgery which deals 
with those injuries produced by violence. This 
group is large and increasing in scope be- 
cause of the modern trend in transportation 
by air, land, and water, the ever increasing 
injuries in the world of sports, and battle, and 
also because of the increasing number of ac- 
cidents in the home. These real emergencies, 
are cared for at the large city institutions, or 
by the community hospitals. These hospitals 
today should be equipped with a fully trained 
personnel to handle every detail of the treat- 
ment of these cases. This technique should 
include not only surgeons with special train- 
ing in traumatic surgery, but also physicians 
trained in anesthesia. Every hospital han- 
dling this type of patient should be staffed 
with an anesthesia department empowered 
with the same authority as the rest of the 
staff. In the hospitals of the larger cities the 
anesthetist supervising the department of 
anesthesia should be a qualified specialist in 
anesthesia with graduate physician anesthet- 
ists as assistants. In the smaller city or com- 
munity hospitals, sufficient staff members 
should be in charge of anesthesia, having pre- 
viously had special training before assuming 
the supervision of this department. In this 
manner every hospital throughout the coun- 
try would have an efficient anesthesia service, 
and one equipped in the modern methods of 
anesthesia for the traumatic surgical patient. 

The acute traumatic emergency usually 
shows varying degrees of shock as the result 
of the combination of trauma to the central 
nervous system, loss of blood and tissue dam- 
age. For this reason they require much more 
attention for anesthesia than the patient seen 
in elective surgery. They may even exceed 
the seriousness of the acute abdomen, one of 
the commonest surgical emergencies. Organ- 

* Read at the 87tli Annual Session of the Maine 

1939. 

J. 

\ 

Graduates. 


ized efficient care of these patients will elimi- 
nate unnecessary pain and suffering, better 
detailed treatment of the injuries by unham- 
pered surgeons, support of the patient’s vital 
functions before, during and after surgery, 
prevention of post-operative complications 
with a more rapid and uneventful convales- 
cence and better end results. 

The first consideration in the care of the 
traumatic surgical patient for anesthesia is 
the classification of these cases into good, bor- 
der line, and bad risks. By being fully ac- 
quainted with the risk of the patient, the 
anesthetist is able to prepare the patient more 
intelligently for anesthesia and operation by 
a wise choice of premedicating drugs and 
anesthetics. In this manner, the condition of 
the poorer risk is supported and improved at 
all times, so that the patient is more able to 
stand the operation and will have a better 
convalescence. 

The good risk patient is one who has a local 
injury with no complicating pathological con- 
ditions. The border line risk patient is one 
who has a severe injury and minor pathologi- 
cal complications or vice versa. The bad risk 
patient is one who has a severe injury and se- 
rious pathological complications. In order to 
arrive at these conclusions, a complete history 
and physical examination, which should in- 
clude blood pressure, pulse, and respirations; 
and laboratory tests, which comprise X-rays, 
urinalysis and blood test if indicated. 

Of prime importance is the consideration 
of the patient’s psychic state which is con- 
trolled with words of encouragement, sugges- 
tion, and drugs. From all this data the anes- 
thetist makes his choice of drugs and 
anesthetics, also the method of administration 
of the anesthetic. 

The drugs used for premedication are mor- 
phia and atropine for ether and avertin anes- 
thesia ; morphia and scopolamine for nitrous 
oxide and oxygen anesthesia ; nembutal, mor- 
phia, and scopolamine for spinal or regional 

Medical Association, Poland Spring, Maine, June 27, 


Instructor in Anesthesia, Harvard University Medical School, Harvard Medical School Courses for 
Anesthetist-in-Chief, Faulkner Hospital. Visiting Anesthetist, Poston City Hospital. 


220 


The Journal of the Maine Medical Association 


anesthesia ; and nembutal, morphia, and atro- 
pine for cyclopropane, G. O. E., and penta- 
tliol anesthesia. The dosages of these drugs 
are regulated according to the age, size, emo- 
tional state, and physical condition of the 
patient as found on examination. In the good 
risk patient the average dosage is adequate. 
In the border line patient the dosages are re- 
duced according to the condition of the pa- 
tient. In the bad risk patient premedication 
should be eliminated or given only in very 
minimum amounts. 

The choice of anesthetics for these cases are 
again based on the classification of the pa- 
tient’s condition, whether good risk, border 
line, or bad risk. In compound skull injuries, 
in good risk patients, avertin (60 to 80 mgms. 
per kilo of body weight) is supplemented by 
ether and oxygen which is administered, 
through an intratracheal tube, in order to pre- 
vent any respiratory depression and also to 
allow for artificial respiration with oxygen 
if needed. In border line risk cases, avertin 
is supplemented with local anesthesia, but 
oxygen shonld be available through a nasal 
tube or oral airway. In the bad risk head 
case, which is presumably in coma, local anes- 
thesia alone may suffice ; if the patient is rest- 
less, fractional doses of pentotlial sodium can 
be administered through the intravenous tub- 
ing, thus keeping the patient under complete 
reflex control. In injuries involving the res- 
piratory tract or mouth complicated by blood 
and foreign bodies, intratracheal cyclopro- 
pane oxygen or avertin and intratracheal 
ether with oxygen is used. Cyclopropane is 
administered intratracheally or through a 
special oral airway such as the Leech airway 
for external injuries to the face. Pentothal- 
sodium intravenously can be used to good ad- 
vantage for the shorter operations about, the 
face or mouth in the good risk patients. Cy- 
clopropane, or nitrous-oxide-ether, is used in 
injuries about the neck or shoulder joints. 
Injuries of the arms and hands may be han- 
dled with cyclopropane-oxygen, brachial plex- 
us block, or field block. For injuries to the 
chest, cyclopropane-oxygen is the anesthesia 
of election because of the high oxygen avail- 
able to the patient with a lowered vital ca- 
pacity, also to make it possible to administer 
the gas and oxygen under positive pressure, 
in order to prevent pneumothorax or dam 


back secretions in the bronchi. Spinal in- 
juries are best handled with nitrous-oxide- 
oxygen-ether or cyclopropane-oxygen intratra- 
cheally, with special precautions being taken 
to support the shoulders and pelvis on pillows 
to relieve interference with diaphragmatic 
excursions, thus preventing respiratory de- 
pression and shock from pressure on the ab- 
domen. In the traumatic abdomen or lower 
extremities, spinal anesthesia is elected in 
good risk cases, and balanced spinal anesthe- 
sia in the border line risk cases. Balanced 
spinal anesthesia consists of premedicating 
drugs combined with minimal doses of the 
spinal agent or agents and supplemented with 
inhalation cyclopropane - oxygen, nitrous- 
oxide-oxygen or ether-oxygen, maintaining a 
high concentration of not less than 500 c.c. of 
oxygen per minute. Local anesthesia with 
novocaine and gas-oxygen is the anesthesia of 
election in the bad risk abdominal and lower 
extremity case. 

In operations about the hip joints, as nail- 
ing of fractures of the neck of the femur, 
where the patient usually falls into the age 
group of 60 to 100 years, and is in the good 
or border line risk class, spinal anesthesia is 
used with minimal amounts of the agent. In 
the extreme age group, as little as 30 mgms. 
of novocaine and 3 mgms. of pontocaine is all 
that is needed. This anesthesia will last from 
iy 2 to 2 hours. In the bad risk patient ni- 
trous-oxide-oxygen and local infiltration with 
novocaine is the safest procedure, keeping 
the oxygen at a maximum concentration. 

Pentothal-sodium intravenously is ideally 
adapted for anesthesia in the short operation 
as reduction of simple fractures and disloca- 
tions or suturing of lacerated wounds. 

The complications from injuries found in 
the traumatic surgical patient differentiate this 
type of patient from the average anesthetic 
problem in surgery. The most common con- 
ditions complicating anesthesia in these cases 
are coma, excitement, alcoholism, shock, hem- 
orrhage, sepsis ; the presence of a full stom- 
ach, nausea, and vomiting; obstructed airways 
from fractured jaws and teeth; impairment 
of respiration from severe neck, chest and 
spinal injuries; such injuries as compound 
fractures and dislocations, and spinal 
injuries. 

Tn the unconscious patient a very careful 


Volume Thirty, No. 9 


Anesthesia for Traumatic Surgery 


221 


history should be obtained from a responsible 
person. If this is impossible, a very complete 
physical examination and laboratory tests 
should be made to rule out other causes for 
the coma than direct injury. In head injuries 
unconsciousness in varying degrees is com- 
mon and the anesthetist must be careful in 
his choice of anesthetic. 

The excited patient usually can be rea- 
soned with and by the power of suggestion 
and with the aid of hypnotic drugs can be 
controlled. The alcoholic patient is a real 
problem for anesthesia, especially when com- 
plicated with severe injury. When alcoholism 
is proven to be present a gastric lavage should 
be done immediately, and as there is usually 
present in the alcoholic, varying degrees of 
cerebral edema, no morphia should be given. 
Very often delirium tremens develop during 
operation under anesthesia or immediately 
post-operatively. For this reason it is best to 
eliminate ether if possible. Spinal anesthesia 
is the anesthesia of election, if indicated. At 
the time of administration it is well to with- 
draw about 20 c.c. of spinal fluid to relieve 
intracranial pressure. 

Paraldehyde given rectally, in dosages of 
15 to 30 c.c. per 100 pounds of weight, mixed 
with starch, ounces 1, and water ounces 5, 
for hypnosis or as a basal anesthetic to be sup- 
plemented by the gases, preferably nitrous- 
oxide-oxygen, as paraldehyde is not well 
adapted to the closed C0 2 absorption system. 

The smaller doses of paraldehyde are used 
for the debilitated, depressed and obese. 

The degree of shock should be determined 
and treated with the usual methods before 
operation is considered unless it is imperative 
to perform an immediate operation. Also the 
degree of hemorrhage should be determined 
by blood pressure, pulse, and general condi- 
tion of the patient, and if severe, transfusion 
should be given. 

If the patient is in the border line risk 
class, and has not needed intravenous fluids 
and transfusions, but shows varying degrees 
of moderate shock, as a prophylactic measure 
it is well to administer intravenous fluid 
(glucose 5% in normal saline) with the be- 
ginning of the operation and have a trans- 
fusion of blood ready for immediate use if 
necessary. 

Continued on 


Too many patients have died from aspira- 
tion of vomitus under anesthetics. This is a 
fact which is more common than generally 
believed. If it is known that the patient has 
a full stomach a gastric lavage should be done. 
If inhalation anesthesia is elected ; it should 
be administered intratracheally. If the pa- 
tient is unconscious and unable to tell his 
story, and the intratracheal method is not 
employed, lie should be carefully watched 
while under anesthesia for any occurring 
vomiting and treated immediately. The anes- 
thetic should be removed immediately and the 
patient allowed to empty his stomach if pos- 
sible or a stomach tube inserted to eliminate 
any liquid vomitus. Direct intubation should 
be done with a laryngoscope and tracheal suc- 
tion should be instituted. Spinal anesthesia 
should be used when possible to prevent the 
dangers of vomiting. 

If the patient vomits during anesthesia, 
whether he shows any signs of obstruction or 
not, he should be bronchoscoped immediately 
in order to prevent postoperative pneumonia 
or atalectasis. If the hospital does not have 
an expert bronchoscopist on the staff, the 
anesthetist should perfect his technique in 
this procedure. 

Foreign bodies in the mouth should always 
be looked for as they may be the cause of ob- 
structed airways. Trauma of the trachea or 
chest wall, or injury to the upper spine 
should be investigated as a cause of impair- 
ment of respiration. 

Excessive secretions of the nose, pharynx, 
or respiratory tract may be the cause of ob- 
structed airways. In the case of fractured 
jaws or teeth, careful examination should be 
made for loose particles and blood clots. If 
foreign bodies are suspected in the lower 
respiratory tract bronchoscopy should be per- 
formed. This type of complication calls for 
the use of the suction apparatus in the naso- 
pharynx, oro-pharynx, and trachea. Cyclo- 
propane-oxygen administered intratracheally 
should be used where these conditions com- 
plicate the normal respiratory exchange. 

In fractures of the spine and compound 
fractures, these parts should be thoroughly 
protected and splinted and the patient han- 
dled properly to prevent any further damage 
to these regions while undergoing anesthesia. 

page 232 


222 


The Journal of the Maine Medical Association 


Tracheotomy — The Bronchoscope as an Aid in Emergency Cases 

Edward L. Pratt, M. D., F. A. C. S., Lewiston, Maine.* 


Tracheotomy is a comparatively simple 
operation when it can be done in a planned 
and orderly manner. In extreme emergencies 
the only instruments needed are a pair of 
hands and a knife. If the hands are trained 
and one has memorized the Jackson technic, 
it can be, and has been, successfully done in 
the dark ( 1 ) . But neither this knowledge, 
nor the fact that tracheotomy has become a 
relatively rare operation, is any excuse for 
the lack of a complete sterile tracheotomy set 
being at all times available for instant use in 
all of our hospitals. 

A survey of a considerable number of hos- 
pitals in our smaller cities and towns finds 
them either totally lacking in proper equip- 
ment for an emergency tracheotomy, or hav- 
ing only a partial, makeshift equipment 
which is usually scattered about in various 
cabinets rather than assembled as a unit. 
Often there are not more than two sizes of 
tubes available — sometimes only one. These 
are often of ancient vintage and unscientific 
design. Many were purchased from the sur- 
plus stock of the IT. S. Army Medical Corps, 
circa 1919-1920. They are made of alumi- 
num or an alloy resembling it ; they are too 
short, have not the proper curve ; have ill- 
fitting cannulae, and have no pilots. Rarely 
were duplicate tubes available. 

Unlike many other emergency operations, 
it is often a matter of seconds rather than 
minutes, which count when an emergency 
tracheotomy has to be performed. Extreme 
dyspnoea, whether due to an inflammatory 
obstruction or an impacted foreign body in 
the trachea, cannot wait upon a search of in- 
strument cabinets for the proper instruments 
and their sterilization after they are found. 
They should be assembled as a unit, wrapped 
up in a sterile tray or towel and labeled 
“Emergency Tracheotomy Set.” This set 
should be instantly available at all times, 
day and night. Each set should contain the 
following: 

1 scalpel and 1 sharp curved bistoury 
6 curved mosquito clamps 


4 Kelly clamps 
2 smooth retractors 

1 tenaculum (useful in steadying and ele- 
vating the trachea) 

1 pair of dissecting scissors 

1 pair, narrow, curved on the flat scissors 
Trousseau dilator 

2 curved needles 

1 needle holder 

2 tubes 1ST o. 0 catgut 

Hypodermic syringe for local anaesthesia 
2 ampules of 1% Xovocaine 
6 sizes of J ackson tracheal cannulae with 
pilots 

Linen tape 1 inch wide to tie the cannula 
2 soft rubber catheters (10 F.) for aspira- 
tion 

The importance of having tracheal cannu- 
lae of proper curve and correct length cannot 
be emphasized too strongly. “Untold thou- 
sands of deaths have occurred from improper 
makeshift cannulae” (2). Unfortunately, 
there are scores of different models of trach- 
eotomy tubes, each differing in curve, calibre 
and length. A tube of one make numbered 4, 
for example, will be found to be of the same 
size as one numbered 6, of another make. The 
curve of a tube manufactured by X Company 
will be found to differ markedly from a tube 
manufactured by Y Company. The same is 
true as regards their length. It is therefore 
of the utmost importance that a duplicate set 
of cannulae of the same model and made by 
the same instrument maker, should always 
be kept at hand. The Jackson cannulae 
made by Pilling & Sons of Philadelphia, like 
the O’Dwver intubation tubes, have stood the 
test of time. 

Every tracheotomy case requires two can- 
nulae ; one to replace the original tube when 
it has to be removed and cleaned. These can- 
nulae should remain the property of the hos- 
pital. If the patient is to be discharged from 
the hospital while still wearing a cannula, 
two cannulae of the same size and make 
should be obtained for him so that the hos- 
pital sets remain unbroken. 


* From the Department of Broncho-Esophogology, Central Maine General Hospital, Lewiston, Maine. 


Volume Thirty , No. 9 


Tracheotomy — The Bronchoscope as an Aid in Emergency Cases 


223 


Tlie technic of the operation need not he 
described here as it can he found in any 
standard surgical treatise. Every surgeon 
should memorize Jackson’s technic of how to 
perform the operation in great emergencies, 
even in the dark (3). Attention is also called 
to an error which still persists in many surgi- 
cal works, namely, that there are two kinds 
of tracheotomy — high and low. Every trach- 
eotomy should be a low tracheotomy ; that is, 
below the second tracheal ring. In rare cases, 
in order to prevent death by asphyxiation, it 
may be necessary to make an opening through 
the crico-thyroid membrane, but this should 
always be followed, not more than 48 hours 
later, by a tracheotomy below the second ring. 
Unless this is done, a perichondritis with a 
resulting stenosis of the larynx is sure to 
follow. 

That the bronchoscope can be of great- 
value in cases requiring emergency tracheo- 
tomy, is well illustrated by the following two 
cases : 

Case I. Miss M. Hosp. Case Ho. 76485. 
Admitted to the Central Maine General Hos- 
pital November 8, 1938. Age 3 !/> ,Y rs - 

Present 111 ness: Patient had had a sore 
throat for a week before a physician was 
called. He discovered that the child was 
hoarse and that there was an extensive mem- 
brane covering the pillars of the fauces and 
extending on to the soft palate and the pos- 
terior pharyngeal wall. He sent her at once 
to the hospital. 

Physical Examination : On admission the 
patient looked very ill. She was extremely 
dyspnoeic, with indrawing of the supra- 
clavicular, suprasternal and epigastric spaces. 
There was a marked expiratory stridor. She 
had an ashen grey color, an anxious expres- 
sion and was very restless. A dirty grayish- 
black membrane covered both tonsils, most 
of the soft palate and extended down the 
pharynx as far as could be seen by depressing 
the tongue. A diagnosis of faucial and laryn- 
geal diphtheria was made. The child was 
admitted to the isolation ward for an imme- 
diate tracheotomy. Because of the extreme- 
dyspnoea and restlessness and because the 
child had a short fat neck, it was decided to 


bronchoscope the child and do the tracheo- 
tomy with the bronchoscope in the trachea. 
A 4mm. Jackson bronchoscope was passed 
into the trachea and with an airway estab- 
lished, an orderly tracheotomy was per- 
formed. The wisdom of this procedure was 
demonstrated at operation when the trachea 
was found to be covered with a deep layer of 
fat, and the two inferior thyroid veins — al- 
most as large as a lead pencil — all but cov- 
ered the anterior surface of the trachea. Had 
the operation been performed without first 
providing a good airway, the haste essential 
for the relief of the extreme dyspnoea al- 
most certainly would have resulted in injury 
to these greatly congested veins, and a fatal 
haemorrhage might have ensued. 

Case II. L. R. Male, Age 7 vrs. Hosp. 
Case No. 76612. Admitted to Central Maine 
General Hospital November 22, 1938. 

Present Illness : Two weeks before admis- 
sion the parents noted that the boy was 
hoarse. A physician was called who pre- 
scribed some medicine and the boy seemed to 
improve somewhat, but a week later the 
hoarseness had increased. Tinct. of Benzoin 
inhalations were prescribed and given for the 
next 48 hours but they failed to relieve the 
hoarseness. About 12 hours before admission 
the boy became aphonic, began to vomit, 
choke and gasp for breath. He became very 
cyanotic and was rushed to the hospital, 20 
miles from his home. 

Physical Examination : On admission he 
appeared very ill. He sat up on the stretcher 
using all his accessory muscles of respiration. 
There was indrawing of the suprasternal, 
supraclavicular and epigastric spaces. He had 
an ashen gray color, dilated pupils and an 
anxious expression. No membrane was seen 
in the oropharynx but there was a dirty gray- 
ish exudate in the hypopharynx and the 
larynx. He was admitted to the isolation 
ward for an emergency tracheotomy. As in 
the first case, the dyspnoea and restlessness 
was so marked that it was thought best to 
pass a bronchoscope and do the tracheotomy 
with the bronchoscope in the trachea. A 6mm. 
Jackson bronchoscope was passed into the 
trachea and an orderly tracheotomy was per- 


Continued on page 232 


224 


The Journal of the Maine Medical Association 


President’s Page 


To the Members of the Maine Medical Association: 

The Wagner Act proposes a revolutionary change in the provision of medical 
and hospital care. 

Why should there be such a change ? 

At the hearing on the Act, Dr. Haven Emerson of The New York City Board 
of Health stated : “No emergency of sickness or neglect faces us.” 

Dr. R. G. Leland, Director of the Bureau of Medical Economics of the 
American Medical Association, said that according to official vital statistics, con- 
stant and continuous improvement in the health of the American people had been 
in progress for many years. 

These statistics showed general improvement in mortality rates except for 
cancer, diabetes, and diseases of the heart and blood vessels. 

The reason for the increased rates in these diseases being that more people 
lived long enough to develop them. 

The figures of Dr. Louis I. Dublin, statistician of the Metropolitan Life 
Insurance Company, show that in 1880 the average expectancy of life at birth in 
the United States was 40 years. In 1938 it had risen to 62 years. 

In 1938 over 98% of the people in the United States lived within 30 miles of a 
registered hospital. 

There were 6,166 registered hospitals with 1,161,380 beds. 

In the general hospitals there was a daily average of 132,454 empty beds. 

The number of beds in the general hospitals is increasing at a rate greater 
than that of population increase. 

Would it not seem sensible to more fully utilize existing facilities before 
embarking upon an enormous new construction program as contemplated in the 
Wagner Act? 

Do the records of the various European systems of State or socialized medi- 
cine indicate that they offer to the American people any advantages over our 
present system? 

They do not. 

Who are back of the proposal to change so radically the American way of 
practicing medicine and running hospitals? 

Dr. Arthur W. Booth, Chairman of the Board of Trustees of the American 
Medical Association, at the hearing, stated: “So far as I am informed, no evidence 
has ever been offered to show that any of the projects embodied in S. 1620 were 
devised by any of the people of the several States, or that enactment of this legis- 
lation is being promoted by them. 

On the contrary, it is understood that every project embodied in this bill was 
devised by appointive federal officials and employees, to be handed down to the 
people on a ‘take it or leave it’ basis.” 

The familiar characteristics of the New Deal philosophy are again demon- 
strated. 

George L. Pratt, 

President Maine Medical Association. 


Volume Thirty, No. 9 


President's Page 


225 


President’s Page 


Collection agencies have been heard from again. 

Every member of the Association knows, or should know, of Dr. 
Gehring’s work on these agencies. The President’s Page of July, 1934, 
should be printed every year, and every member should study it. 

G. L. Pratt, 

President Maine Medical Association. 


Stop * * Look * * Listen 

TO THE MEMBERS OF THE MAINE MEDICAL ASSOCIATION : 

NEVER SIGN EITHER A CONTRACT OR A NOTE WITH ANY COL- 
LECTOR’S AGENCY. IN-STATE OR OUT-OF-STATE, NO MATTER BY WHOM 
SUCH AGENCY IS RECOMMENDED. ANY SOLICITOR OR AGENT WHO 
WANTS YOUR ACCOUNTS FOR COLLECTION SHOULD AROUSE YOUR 
SUSPICION AT ONCE IF HE ASKS FOR YOUR SIGNATURE EITHER TO A 
NOTE OR A CONTRACT. LEGITIMATE COLLECTION BUSINESS DOES NOT 
HAVE RECOURSE TO NOTES OR CONTRACTS. 

FAILURE TO APPRECIATE THE FOREGOING IS RESPONSIBLE YEARLY 
FOR THE LOSS OF THOUSANDS OF HARD-EARNED DOLLARS TO MAINE 
PHYSICIANS. 

IN THE FUTURE, BEFORE YOU PLACE ANY ACCOUNTS FOR COLLEC- 
TION WITH ANYBODY. WRITE THE SECRETARY OF YOUR STATE ASSO- 
CIATION FOR INFORMATION CONCERNING THE PERSON OR FIRM IN 
QUESTION. TO RENDER SUCH SERVICE TO OUR MEMBERS IS ONE OF 
THE DUTIES OF OUR COUNCIL. MOREOVER. TO RECEIVE SUCH SERVICE 
IS ONE OF THE PRIVILEGES WHICH MEMBERSHIP IN A COMPONENT 
COUNTY MEDICAL SOCIETY CONFERS. 

REMEMBER! SOLICITORS OR AGENTS OR COLLECTORS ARE MORE 
OR LESS CONSTANTLY IN OUR MIDST. THEIR SCHEMES FOR GETTING 
MONEY WHERE OTHERS. INCLUDING YOURSELF, HAVE FAILED. ARE 
INTRIGUING AND LEGAL. HOWEVER ALLURING THEY MAY SOUND, IF 
THEY INVOLVE THE SIGNING OF A CONTRACT OR A NOTE, REFUSE TO 
CONSIDER THEM ALTHOUGH THEY MAY BE SPONSORED BY GROUPS 
OF PHYSICIANS OR CHAMBERS OF COMMERCE. 

IN EVERY INSTANCE, CONSULT YOUR STATE ASSOCIATION’S SEC- 
RETARY AND HAVE YOUR EYES OPENED, BUT DON’T SIGN A NOTE OR 
A CONTRACT. 


E. W. GEHRING. 


226 


The Journal of the Maine Medical Association 


Editorial 

The Address of Senator Robert A. Taft 


The Journal of the A.M.A., issue of 
July 29, 1939, prints an address given by 
Senator Taft at the laying of the corner 
stone of the Doctor’s Hospital in Washing- 
ton on July 11th, which contains many 
remarks on the subject of socialized medicine 
and attempted government control most 
worthy of study and thought. Senator Taft 
as a member of the sub-committee of the 
Senate that heard the arguments concerning 
the Health Bill proposed bv Senator Wagner 
of Hew York is also in the position, as a 
member of the bar, to point out the inherent 
dangers of the measure as it is proposed. 
While the views expressed in this address 
are in direct opposition to those presented 
not long ago before the House of Delegates 
of the American Medical Association by the 
late Senator J. Ham Lewis, who openly 
advocated the control of the profession of 
medicine by the Federal government, they 
contain many thoughts of great concern — 
concern not only to the members of the 
profession of medicine, but to every other 
profession and to the people of this nation 
as a unit. 

Stating in his opinion that the present 
Wagner Bill will not be pressed at this ses- 
sion, he does feel that in 19 JO a federal pro- 
gram of some kind will be adopted. “What 
form it takes depends largely on the medical 
profession,” and he expresses the hope, 
which is probably father to the wish, that 
the medical profession will, through its 
National and State Societies, determine the 
program that can be adopted to improve the 
health of the American people and the prac- 
tical measures as to how that program shall 
be assisted and made to work. 

Calling specific attention to the needless 
complications of the Wagner Bill, he points 


out that every State adopting the plan will 
have six separate divisions, with an advisory 
committee for each plan, and for the country 
as a whole there will be some three hundred 
different hoards largely composed of laymen. 
Any federal health program should, he 
states, be consolidated under one head, and 
each State program, as far as is possible, 
should be under a single State department. 
He also agrees with the opponents of the 
bill that while a specific program for social- 
ized medicine is not contained at present, it 
is definitely proposed by those who favor 
such a measure and who regard the bill as a 
vehicle to put into effect that which will 
most definitely accomplish the purpose they 
have in mind. 

Emphasizing the hope that the unequaled 
medical service that is received by and is 
available to most Americans can and will be 
extended so that all who are inclined can 
obtain it, he feels without question that if 
the profession shows the interest and partici- 
pation that it should, it will make certain 
the fact that the health and welfare of the 
people will not be “dominated by half-baked 
theorists and those who believe in a totali- 
tarian state” and that a Federal aid pro- 
gram can and will be worked out which will 
be much simpler, decidedly more economical 
and also will preserve the essential inde- 
pendence of the individual members of the 
profession which cannot be possible under 
the Wagner Bill. Professional independence 
means far from advocating any trade union 
principles which can have no part in a pro- 
fession practised as a profession, but one 
must contemplate, with dire misgivings, the 
hope that a professional status would obtain 
under the bill proposed by Senator Wagner. 


Volume Thirty, No. 9 


Necrology 


227 


Necrology 



Henry Sprince, M. /).. 

1898-1939 


Born August 15, 1898, Paris, France. Died 
Friday, August 4, 1939. He practiced medicine in 
Lewiston for fourteen years and was throughout 
this period a member of the Staff of the Central 
Maine General Hospital as Assistant Surgeon and 
in 1935 received the additional appointment as 
Assistant Obstetrician. 

He came from France as a small boy, attended 
the Lewiston High School and will be remembered 
by that school as the author of their official school 
song, “L. H. S. Forever.” Dr. Sprince entered 
Bowdoin College in the fall of 1916. In 1918 he 
enlisted in Infantry and served until Armistice 
was declared, returning to Bowdoin where he com- 
pleted his courses and was graduated in 1920. Dur- 
ing his student days at the Bowdoin College he 
wrote the famed “Polar Bear” song. In the fall of 
1920 he matriculated at the Bowdoin Medical 
School until it was discontinued, and completed 
his medical studies at McGill University College of 
Medicine. In 1923 he interned at the Kings Park 
Hospital at Long Island, New York, and the fol- 
lowing June became House Physician at the Cen- 
tral Maine General Hospital for one year, after 
which he assumed his practice in Lewiston. 

Dr. Sprince was at all times a student as well as 
a practitioner of medicine. In his earlier years he 
demonstrated a keen interest and broad under- 
standing of endocrine disturbances. As a result of 
this interest in endocrinology he was awarded a 
Bowdoin Scholarship in 1930 and spent six months 
in the Lying-in Hospital, Kemp Park Hospital and 
at the Clinics of Dr. Mazer in Philadelphia, con- 
centrating in endocrines and their relation to 


gynecological disturbances. For the last four years 
Dr. Sprince was awarded Bingham Fellowships in 
endocrinology at the Massachusetts General Hos- 
pital and the New England Medical Center. 

Dr. Sprince was a versatile musician. At Bow- 
doin he was the leader of the Banjo Club and con- 
ducted his own orchestra at various summer re- 
sorts. In a Glee Club concert under the auspices of 
Bowdoin College he presented his own jazz version 
of the “Peer Gynt” suite under the title of “Peter 
Gint.” Lewiston was charmed by his entertaining 
talents, particularly as a tenor in the Parker Glee 
Club, and he was widely applauded for his unusual 
skill in the conduction of various operettas. 

The Doctor was a member of the Androscoggin 
County Medical Society and a Fellow of the Ameri- 
can Medical Association, a member of the Masonic 
bodies and the Shrine, of the local Kiwanis Club, 
B’nai B’rith, and of Beth Jacob Synagogue. 

He was married in December, 1924, to Miss 
Normal Rothschild of Montreal. 

He is survived by his wife and a son, Richard. 

Dr. Sprince demonstrated a fortitude and stoi- 
cism during his years of illness rarely possessed by 
one so well acquainted with a disease which he 
knew could not be conquered. Despite this knowl- 
edge he brought health, solace and cheerfulness to 
many homes both in a professional capacity and as 
an inspiring friend — always attempting to bring to 
others a message of health and hope which he 
knew was denied to himself. His passing is an 
irreparable loss to the community which he en- 
riched and served so well as a true physician. 


228 


The Journal of Maine Medical Association 


County Note 

Waldo 

It is very gratifying to receive information that 
Carl H. Stevens, Councilor of the Fourth District, 
who was seriously injured in an automobile acci- 
dent, is making an excellent recovery. 


Coming Meetings 

Maine Medical Association. Fall Clinical Session, 
Wednesday and Thursday, October 25-26, 1939, 
Waterville. Watch for the Program in your 
October Journal. 

Vermont State Medical Society. Annual Session at 
Burlington, October 5-6, 1939. Benjamin F. 
Cook, 154 Bellevue Avenue, Rutland, Vermont, 
Secretary. 


Notices 


Examinations 

American Board of Obstetrics and 
Gynecology 

The next written examination and review of 
case histories (Part I) for Group B candidates 
will be held in various cities of the United States 
and Canada on Saturday, January 6, 1940, at 2.00 
P. M. The Board announces that it xoill hold only 
one Group B, Part I, examination this year prior 
to the final general examination, instead of two as 
in former years. Candidates who successfully com- 
plete the Part I examination proceed automatically 
to the Part II examination held in June, 1940. 

Applications for admission to Group B, Part I, 
examinations must be on file in the Secretary’s 
office not later than October 4, 1939. 

The general oral and pathological examinations 
(Part II) for all candidates (Groups A and B) 
will be conducted by the entire Board, meeting in 
Atlantic City, N. J., on June 8, 9, 10 and 11, 1940, 
immediately prior to the annual meeting of the 
American Medical Association in New York City. 

Applications for admission to Group A, Part II, 
examinations must be on file in the Secretary’s 
office not later than March 15, 1940. 

After January 1, 1942, there will be only one 
classification of candidates, and all will be required 
to take the Part I examinations (written paper 
and case records) and the Part II examinations 
(pathological and oral). 

For further information and application blanks, 
address Dr. Paul Titus, Secretary, 1015 Highland 
Building, Pittsburgh (6), Pennsylvania. 


Ragweed Survey, 1939 

Two pollen receiving stations are being operated 
for the 1939 Ragweed Survey. One at Portland on 
the roof of the Maine General Hospital under the 
supervision of the hospital Superintendent and the 
other at Camden under the auspices of the Camden 
Chamber of Commerce. These stations which were 
opened August 10th will be continued for fifty days. 


State of Maine Board of Registration of 
Medicine 

Physicians licensed to practice medicine and sur- 
gery in Maine on July 12, 1939: 

Through Examination 

William Champlin Burrage, M. D., Portland, 
Maine. 


Harry Edward Christensen, M. D., Portland, 
Maine. 

Joseph Francis Dinan, M. D., Boston, Mass. 

John Francis Dougherty, M. D., Bath, Maine. 
Edward Thomas Driscoll, M. D., Worcester, Mass. 
Lucio Ernest Gatto, M. D., Cambridge, Mass. 
Harold Floyd Gilbert, M. D„ Mt. Holly, N. J. 
Napoleon Gingras, M. D., Augusta, Maine. 

Marlin Charles Moore, M. D., Kulpmont, Penna. 
Arthur Ames Nichols, M. D., Boston, Mass. 

John Coleman Nunemaker, M. D., Boston, Mass. 
Richard Rapp Owens, M. D., MacMahan Island, 
Maine. 

Maurice Swain Philbrick, M. D., Skowhegan, 
Maine. 

George Emil Ronne, M. D., Pawtucket, R. I. 
Robert Borden Somerville, M. D., Bristol, N. B„ 
Canada. 

Douglass Willey Walker, M. D., Thomaston, 
Maine. 

Lester Ray Whitaker, M. D., Portsmouth, N. H. 
Russell Wigh, M. D., Boston, Mass. 

Fredrick Francis Yonkman, M. D., Boston, Mass. 

Through Reciprocity 

Frederick S. Gray, M. D., Portsmouth, N. H. 
Allen Harold Knapp, M. D„ Calais, Maine. 
Stanley Walter Machaj, M. D„ Portsmouth, N. H. 
James Calvin Martin, M. D., Baltimore, Md. 
James Mitchell Parker, M. D., Chestnut Hill, 
Mass. 

Arthur Gilson Pilch, M. D., Bloomfield, N. J. 
George Capron Poore, M. D., Philadelphia, Pa. 
Irvin Robert Schaen, M. D., Cincinnati, Ohio. 


Tumor Clinics* 


Portland: 


Lewiston : 


Waterville: 


Bangor: 


Maine General Hospital — Thursday, 

11.00 A. M.-12.00 M. Director, Mor- 
timer Warren, M. D. 

Central Maine General Hospital — 
Tuesday, 10.00 A. M.-12.00 M. Di- 
rector, E. V. Call, M. D. 

St. Mary's Gener al Hospital — Wednes- 
day, 4.00 P. M. Director, R. A. Beli- 
veau, M. D. 

Thayer Hospital — Thursday, 9.00- 

11.00 A. M. Director, Edward H. 
Risley, M. D. 

Sisters' Hospital — Thursday, 9.00- 

11.00 A. M. Director, Blynn O. 
Goodrich, M. D. 

Eastern Maine General Hospital — 
Thursday, 11.00 A. M.-12.00 M. 
Director, Magnus F. Ridlon, M. D. 


* Approved by Maine Medical Association. 


Volume Thirty, No. 9 


Book Reviews 


22 9 


Book Reviews 


“ How to Play Golf ’ 

By Ben Thompson, Yale Golf Coach. Published 
by Prentice-Hall, Inc., New York. 

It has been feelingly said that golf is the only 
game that one pays to suffer. For quite some time 
certain players, ghost writers and other parrots of 
like ilk have filled the pages of golf magazines 
with articles on “instruction” that have resulted in 
confusion and worse. The end result of all this 
gibberish is that the average player tries the 
proposed nonsense, finds his troubles even worse, 
reverts back to his own particular ideas or those of 
his friends of what a golf swing should be and 
confidingly but dumbly hopes for the best. His 
medal scores mount with an increasing sense of 
irritation and defeat and he strives to find solace 
and peace on the “19tli” with his fellow sufferers. 

The author speaks from years of experience as a 
teacher and player. It is extremely refreshing to 
read such a sane and sensible book of instruction, 
free from silly and nonsensical theories, and the 
player who will read and study the advice given, 
be he one of skill or desiring it, will obtain much 
of profit and pleasure. Thompson states in his 
preface: “Golf is a pleasant game if the player 

accomplishes pretty much what he aims at; it is 
usually a source of vexation and profanity if it 
fails. To make the game pleasant and easy — as a 
matter of fact it is— is the goal of instruction, and 
to that end this book is dedicated.” 

The book is heartily recommended to those who 
would find a way out of their difficulties resulting 
from the mistaken ideas of the few basic funda- 
mentals around which a successful and enjoyable 
game is made. 

F. H. J. 


“ New and Non-official Remedies ” 

Published by The American Medical Association, 
Chicago, 1939. Price, $1.50. 

“ Annual Reprint of the Reports of the 
Council on Pharmacy and Chemistry 
of the American Medical 
Association for 1938 ” 

Published by The American Medical Association, 
Chicago, 1939. 

This year’s revision presents a number of 
changes. Several preparations previously listed 
have been omitted by reason of non-conformity to 
certain standard requirements. Many others have 
been removed because they were talcen out of the 
market. Many articles describing preparations 
previously listed have been revised to conform 
with present-day perfection of their composition, 
purity, strength, action, uses, and dosage. The 
present issue comprises five hundred thirty-one 
pages of text, eighty-three pages of general index 
and sixty-seven pages of bibliographic index. 

The annual reprint of the reports are contained 
in a small book of one hundred twenty pages. This 
booklet was published in order to make these re- 
ports available to physicians, chemists, pharma- 
cologists, and any others who may be interested 
in medicine and the Council’s report on the articles 
considered. 


“ Superfluous Hair and Its Removal ” 

By A. F. Niemoeller, A. B., M. A., B. S„ Author 
of “Feminine Hygiene in Marriage,” etc. Foreword 
by M. H. Marston, M. D. Published by the Harvest 
House, New York, 1938. Price $2.00. 

Concerning hair removers, the author writes: 
“In order to guard the reader against fraudulent 
advertising and the golden promises of quacks, it 
may be well here to state clearly and definitely 
that regardless of what claims may be made by 
the manufacturers or by whom their products are 
said to be endorsed, there is no known drug, paste, 
lotion or application of any sort that may be ap- 
plied to the skin and effect a permanent removal 
of hair there.” Now this statement left to itself 
could not fill a book. However, the author did 
write this hundred and fifty page book while tell- 
ing the reader how men and women of past and 
present ages take care of hair which they consider 
superfluous. It seems that the human mind has 
been able to discover that hair growing anywhere 
on the human body above the soles of the feet can 
and has been considered superfluous and then this 
same human mind devised means and methods for 
removing hair thus designated, and rationalizes 
the habit of doing so. 


“In the Name of Common Sense 
Worry and Its Control” 

By Matthew N. Chappell, Ph. D. Published by 
The Macmillan Company, New York, 1938. Price, 
$1.75. 

This small volume of 188 pages seems to have 
caught the reader’s eyes. Published in March, 
1938, it had to be reprinted six times before the 
end of the year in order to supply the demand. 
The book is written for and about normal people 
and offers nothing to those interested in the 
psychoses. 

The author tells his readers that “worry is a 
luxury — one that neither the individual nor the 
civilization can afford. A more expensive luxury 
would be difficult to imagine. The cost to the 
individual is to be reckoned in terms of illness; 
bills for doctors, nurses, hospitals, and medicines; 
in loss of wages and opportunities, and ineffi- 
ciency; in terms of mental agitation, irritability, 
family discord, undesirable personality traits, and 
adverse influence on friends, family and children.” 
The reader is placed before his worries as if they 
represented a mirror reflecting qualities which are 
of negative value in the individual’s life for suc- 
cess. He is encouraged to laugh off his foolish 
fears and practice sanely controlled emotional 
activity. 


“ Syphilis and Its Accomplices in Mischief : 
Society , the State and the Physician ” 

By George M. Katsainos, M. D. 

Privately printed at Athens, Greece, 1939. Price, 
$5.00. 

It is very evident that the author of this book 
experienced almost insurmountable difficulties of 
many kinds from inception to completion of his 
present work. The book is rather unusual in many 
ways. It consists of 675 pages; these are neither 
bound nor cut. Apparently it was conceived in 


230 


The Journal of- the Maine Medical Association 


New England, composed and printed in Athens, 
Greece, by a man who is said to be able to set type 
in every European language but knows no English, 
and to be sold to the English-reading world. The 
original plan was that about one-fifth of the text 
should appear in the form of footnotes, but the 
present edition is printed in uniform type; that is 
to say, the footnote information is incorporated in 
the main text. There is no index and no bibliog- 
raphy, even though the text teems with quotations 
from many authors of ancient Greece, European 
and American medical and lay literature, ranging 
from the fifteenth to the present century. To all 
appearances, the author is a fine Greek scholar, 
deeply rooted in early Greek tradition and spirit, 
and is well versed in the Greek language. 

The hook is written in the conviction that its 
author possesses a wealth of truthful knowledge 
concerning syphilis and all its many intertwining, 
complicating ramifications, including the various 
modifications of the human element constantly 
expressed during the many and varied patient- 
physician relationships which may be encountered 
by any practitioner while working with syphilis 
as a disease as such, as a specific infection of a 
certain kind of a person, or as a particular form of 
regime in individual-family-society behavior. To 
be able to conceive of the possibility to verbally 
clarify such a complicated conglomeration of situ- 
ations and to dare hope to be able to devise methods 
by which the problems resulting from all possible 
conflicts can be solved to the satisfaction of all 
concerned, presupposes a clear, mature mind, a 
wide range of knowledge, much spiritual ambition 
and courage, physical endurance, and above all, 
almost superhuman wisdom. It seems almost 
inconceivable that somewhere there lives now one 
man who possesses all of these attributes. In order 
to fulfill his mission, “To clear syphilis of its 
asyphilon,” the author must possess all of them 
and many more. One may honor and respect all 
the excellent qualifications which Dr. Katsainos 
may possess as a man, a scholar, and as a physi- 
cian, but careful study of the book under review 
gives the impression that he attempted too much 
alone. 


“ The Patient as a Person — A Study of the 
Social Aspects of Illness” 

By G. Canby Robinson, M. D., LL. D., Sc. D., 
Lecturer in Medicine, Johns Hopkins University. 

Published by The Commonwealth Fund, 41 East 
Fifty-seventh Street, New York, N. Y., 1939. Price, 
$3.00. 

Quite contrary to some of the modern ideologies, 
every human being differs from every other human 
being in an indefinite number of ways. Some of 
the most demonstrable differential characteristics 
have their bases in sex, race, age, constitutional, 
personal and familial make-up primarily due to 
inheritance, secondarily to early environment, 
childhood experiences, education, economic varia- 
tions and many other factors. Somewhere within 
this singularly occurring composition of a human 
being lie dormant the causes for his feeling of 
well being and of ill health. Because of this singu- 
larly occurring make-up, medical art must devise 
methods for reaching and adequately serving the 
individual while medical science discovers and in- 
vents mechanical systems and appliances by which 
similar reaction responses to similar stimuli may 
be investigated in a definite number of similarly 
constituted but individually differently-reacting 


individuals. This dissimilar similarity which 
always exists in the person investigated, the 
patient, as well as in the person investigating, the 
doctor, must be better understood by both for best 
results. No doctor can afford to disregard this 
basic truth. Consequently, the whole of man, 
alone as a self-contained unit as well as a changing 
unit in a changing environment, must be included 
in his medico-scientific investigation as well as in 
the practice of his medical art for the purpose of 
reestablishing this human unit in an environment 
most appropriate to his needs after he had lost his 
hold while placed in a situation of maladjustment 
by disease, accident, or other uncontrollable alter- 
ations in himself or his environment. To determine 
the elements which often enter into the illness of 
the patients under investigation was the purpose 
of the study carried out in 1936-37 in the Johns 
Hopkins Hospital. The results are presented in 
the form of detailed case reports and comprise a 
total of 174 patients, studied intimately in all 
phases for a period of six months. In the reports 
here presented, no patients have been omitted, 
because it was deemed highly desirable to give the 
complete picture of each case. 


“Surgery of the Eye” 

By Meyer Wiener, M. D., Professor of Clinical 
Ophthalmology, Washington University School of 
Medicine, St. Louis, Mo.; and Bennett Y. Alvis, 
M. D., Assistant Professor of Clinical Ophthalmol- 
ogy, Washington University School of Medicine, 
St. Louis, Mo. 

Published by W. B. Saunders Company, Phila- 
delphia, London, 1939. Price, $8.50. 

The volume under review represents an atlas of 
surgical technique for the eye surgeon. It is dedi- 
cated to that master eye surgeon, Dr. Charles E. 
Michel. The authors did not attempt to create a 
reference work. They present in detail that type 
of operative technique which they found most 
ideally applicable to the condition under treat- 
ment. The descriptions of the operations are 
excellently illustrated with masterful drawings 
executed by Dr. A. J. Hofsommer, thus assuring 
anatomically and technically correct pictorization 
of the steps involved. Surgeons specializing in the 
art of reconstructing the form and function of 
the eye will be pleased with this new addition to 
medical literature. 


“Heart Patients — Their Study and Care” 

By S. Calvin Smith, M. D., Sc. D. Formerly 
special heart examiner for the Surgeon General’s 
Office during the World War at Home and Abroad; 
author of “Heart Affections: Their Recognition 

and Treatment”; “Heart Records: Their Inter- 

pretation and Preparation”; “How Is Your Heart?” 
(New York and London) ; “That Heart of Yours.” 

Published by Lea & Febiger, Philadelphia, 1939. 
Price, $2.00. 

It seems that of the several small books that 
have been written in the past on the care of the 
heart, this is the best of them all. During about 
twenty-five years of specialization on patients with 
heart troubles, Dr. Smith has brought together 
into this pocket-sized volume a great wealth of 
practicable wisdom applicable in every day’s med- 
ical practice. The author’s long experience taught 
him the simple truth: “The heart is far more 


Volume Thirty, No. 9 


Book Reviews 


231 


sinned against than sinning.” In readily under- 
standable language, he describes directly, con- 
cisely and constructively what is known about 
heart affections and what must be known about 
the modern trend in dealing with persons suffering 
from some form of abnormal heart function. Again 
and again he reminds the reader that it is often 
more important to learn more of the patient that 
complains of heart trouble than to concentrate on 
the particular heart that tries to serve well a 
person in conflict with his everyday way of living. 
He considers the heart as a barometer of the 
emotions; consequently, the understanding physi- 
cian must try to ease the patient whose heart is 
burdened with fears, worries, anxieties, etc. It, 
therefore, is the duty of every doctor to detect, 
assuage, and if possible eradicate the emotional 
conflict often concealed by heart patients’ com- 
plaints. Not to have read Dr. Smith’s “Heart 
Patients” is like traveling alone abroad without 
an old friend’s wise counsel. 


“ Diseases of the Nose and Throat ” 

By Charles J. Imperatori, M. D., F. A. C. S. Pro- 
fessor of Otolaryngology, New York Polyclinic 
Medical School and Hospital; Formerly Professor 
of Clinical Otolaryngology, New York Post-Grad- 
uate Medical School, Columbia University, New 
York; Consulting Laryngologist to Nyack General 
Hospital and Harlem Hospital, New York; Con- 
sulting Bronchoscopist to Manhattan Eye, Ear and 
Throat Hospital, Fifth Avenue, and Flower Hos- 
pital and Riker’s Island Hospital, New York; and 


Herman J. Barman, M. D., F. A. C. S. Adjunct Pro- 
fessor of Otolaryngology, New York Polyclinic 
Medical School and Hospital; Formerly Assistant 
Professor of Clinical Otolaryngology, New York 
Post-Graduate Medical School, Columbia Univer- 
sity, New York; Director of the Department of 
Otolaryngology, Harlem Hospital, New York; Con- 
sulting Bronchoscopist to Broad Street Hospital 
and Pan-American Clinics, New York. 

Published by the J. B. Lippincott Co., Philadel- 
phia, 1939. Price, $7.00. 

The material in this text is so arranged that 
the senior medical student and the general prac- 
titioner progresses systematically from the pa- 
tient as a person through the symptoms which he 
presents to the diagnosis and the treatment of 
his pathologically functioning body. This form of 
presentation was carried over from the first into 
the body of this, the second edition, but there 
have occurred a great many changes and addi- 
tions which were necessitated by the rapid prog- 
ress in this field. The description of office proce- 
dure and therapeutic technic is usually given in 
full detail in order to insure greater success in 
the attainment of best results. The technical and 
the anatomical illustrations are excellent. Some 
of the pathological reproductions, however, would 
certainly gain in attractiveness if those with un- 
sightly oval ocular blotches, like Fig. 49, 52 and 
218, were replaced with square or rectangular 
masks similar to those on Page 102 (Fig. 68 to 
73) if such obliterations are necessary or re- 
quested. This is an excellent textbook but good, 
inoffensive illustrations always make a good book 
better. 



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two insufflations of Wyeth’s Compound 
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Vaginal Suppositories usually result in 
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trichomonas vaginitis and the disappear- 
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232 


The Journal of the Maine Medical Association 


Dr. Wiggin — Continued from page 221 


Conclusion 


Traumatic surgical cases are different 
from general surgical patients because they 
present such a variety of complications neces- 
sitating emergency treatment, which deserve 
special attention in anesthesia by experienced 
ph ysicians. The proper choice of premedi- 
cating drugs, anesthetics and the methods of 


administration are of great importance to the 
safety and comfort of the patient, allowing 
for rapid and complete operation by the un- 
hampered surgeon. The recognition and prop- 
er treatment of complications in these cases 
is imperative. 


Dr. Pratt — Continued from page 223 


formed under local anaesthesia. No difficul- 
ties were encountered and the boy made an 
uneventful recovery in spite of having had a 
laryngeal diphtheria for over two weeks. 

This case illustrates a practice all too com- 
mon and one that cannot too strongly be con- 
demned, namely, prescribing for hoarseness 
without ascertaining the cause of the hoarse- 
ness. It is an extremely common practice in 
dealing with children and bv no means un- 
common in adults. It is responsible for count- 
less number of deaths either from toxemia or 
advanced carcinoma. No case of hoarseness 
should be treated without first obtaining a 
good look at the larynx, any more than an 


earache should be treated without looking at 
the eardrum. 

In children suffering from severe dyspnoea 
the use of the bronchoscope should be routine 
in all cases where a tracheotomy is to be per- 
formed. It immediately establishes an ade- 
quate airway; it relieves intrathoracic pres- 
sure ; it converts a frightened, struggling 
child into a quiet one who has lost his ap- 
prehension ; it converts a hurried operation 
into an orderly one; the tube in the trachea 
serves as a guide to the surgeon. 

(1) The Larynx and its Diseases; Chevalier Jack- 

son and Chevalier L. Jackson. Page 459. 

(2) Ibid. Page 455. 

(3) Ibid. Page 459. 


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FOR INFORMATION ADDRESS 
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PROCEEDINGS 


at the 


EIGHTY-SEVENTH ANNUAL SESSION 

of the 

MAINE MEDICAL ASSOCIATION 

held at 

THE POLAND SPRING HOUSE 
POLAND SPRING, MAINE 

JUNE 25, 26, 27, 1939 


HOUSE OF DELEGATES 


ELECTION OF THE PRESIDENT-ELECT 


234 


The Journal of the Maine Medical Association 


FIRST MEETING OF THE HOUSE OF 
DELEGATES, JUNE 25, 1939 

The Opening Session of the House of Delegates 
of the Maine Medical Association convened on 
Sunday, June 25, 1939, at four-fifty in the after- 
noon, at the Poland Spring House, Poland Spring, 
Maine, with Dr. George L. Pratt, of Farmington, 
President-Elect of the Maine Medical Association, 
presiding. 

Chairman Pratt: The meeting will please 

come to order. The Secretary will now call the 
roll. 

(The Secretary called the roll and the following 
delegates responded ) : 

Androscoggin County: W. E. Webber, Lewiston. 

Aroostook County: H. E. Small, Fort Fairfield. 

Cumberland County: L. A. Brown, W. D. Ander- 
son, Ralph A. Heifetz, D. H. Daniels, Portland; 
J. C. Oram, South Portland. 

Franklin County: C. C. Weymouth, Farmington. 

Hancock County: M. A. Torrey, Ellsworth. 

Kennebec County: Samuel H. Kagan, Augusta; 
Charles E. Towne and Howard F. Hill, Waterville. 

Knox County: Howard Apollonio, Camden; A. J. 
Fuller, Pemaquid. 

Oxford County: E. M. McCarty, Rumford. 

Penobscot County: L. J. Wright, Henry C. 

Knowlton, Forrest B. Ames, Bangor; L. H. Smith, 
Winterport, Alternate. 

Sagadahoc County: A. F. Williams, Togus. 

Somerset County: W. PI. Walters, Fairfield. 

Waldo County: Carl H. Stevens, Belfast, Alter- 
nate. 

York County: S. A. Cobb, Sanford; C. W. King- 
horn, Kittery. 

Chairman Pratt: We have a sufficient number 
for a quorum. I would say that the Councilors are 
also members of the House of Delegates. I hope 
you will pardon my short-comings as a presiding 
officer as I am not a parliamentary expert, but I 
will agree to carry on. 

There is one thing I would like to say at the 
start. We frequently, or sometimes at least, find 
after things get into print that it is something 
incorrect or something we didn’t want to get out. 
I would, therefore, ask all reporters, or anyone 
who has anything to print, to kindly submit the 
matter to our Publicity Committee first. Dr. 
Thomas Foster is the Chairman of that Committee 
and on that point Dr. Jackson would like to say 
just a word on behalf of the Journal. 

Dr. Frank H. Jackson, Houlton, Editor The 
Journal of the Maine Medical Association : Last 
year, as you know, we published in full the tran- 
sactions of the House of Delegates. The general 
request is that every member who addresses this 
House, as long as this is a permanent record, will 
please give his name and address before he speaks, 
because we are going to be obliged to delete any 
and all matters that come up in which it simply 
states, as it did last year several times, “A Doctor.” 

Now, please remember that what goes on in the 
House of Delegates is important to this Associa- 
tion. You, and you alone, can make certain pro- 
nouncements, and you have laid down certain 
things that we must follow. It is very interesting, 
and it is also important, that the members who are 
unable to attend these sessions know what you do 
and what you say. A great deal of this matter 
leaks into the public press and also leaks, some- 
times, into hands that are hostile to us. 

Therefore, please give us the benefit of knowing 
who is speaking. If there is anything that we 


think should be omitted in publishing or printing, 
we will take care of that part of the situation, but 
your remarks as spoken stand here, and they are 
a matter of record in the Journal of the Society. 

Chairman Pratt: I will appoint the Reference 
Committee to consider a resolution which may be 
referred to them: Dr. Ebbett, of Houlton, Chair- 
man, Dr. Wallace E. Webber, of Lewiston, Dr, 
Kinghorn, of Kittery. 

I also appoint the following Nominating Com- 
mittee, consisting of one delegate from each Coun- 
cilor District: from the Fifth District, Dr. R. V. N. 
Bliss of Blueliill, Chairman; from the First Dis- 
trict, J. C. Oram, South Portland; from the Sec- 
ond District, E. M. McCarty, Rumford ; from the 
Third District, Howard Apollonio, Camden; from 
the Fourth District, Samuel H. Kagan of Augusta; 
from the Sixth District, Forrest B. Ames, Bangor. 
I will say that this committee will meet in the hall 
with the Chairman and be ready to present your 
nominations at the second meeting of the House 
tomorrow afternoon at 5.30. I would also like to 
ask the delegates from the First and Second Dis- 
tricts to meet and be ready to present their nom- 
inations for Councilor in each one of these Dis- 
tricts at the same time. 

The next article of business will be the report 
of the Council, to be made by the Chairman, Dr. 
Foster. 

Dr. Thomas A. Foster, Portland, Councilor from 
the First District, Chairman of Council: Mr. Presi- 
dent and Delegates: (Dr. Foster read the follow- 

ing reports: First meeting of the Council for 1938- 
1939 held at Bar Harbor, June 28, 1938; second 
meeting held at Searsport, July 31, 1938; the finan- 
cial statement of the Eighty-Sixth Annual meeting 
of the Maine Medical Association, held at Bar 
Harbor, June, 1938; third meeting of the Council 
held at Waterville, September 11, 1938; fourth 
meeting held at Lewiston, November 3, 1938, at 12 
o’clock noon; fifth meeting held at Lewiston, No- 
vember 3, 1938, at 5.30 p. m.; and sixth meeting 
held at Lewiston, November 3, 1938, at 10.30 p. m.). 

Dr. Foster: There are the six meetings re- 

ported, and I have in addition Council business 
transacted by mail. (Dr. Foster read report of 
Council business transacted by mail.) 

Dr. Foster: That concludes the report of the 

Council. 

Chairman Pratt: You have heard the report of 
the Chairman of the Council. What action will 
you take? 

A Member: I move it be accepted. 

This motion was duly seconded and carried. 

Chairman Pratt: The next article of business 
is the presentation of the 1939-1940 budget as 
recommended by the Council, and will be pre- 
sented by Dr. Foster. 

Dr. Foster: This isn’t going to be as long, so 
don’t get wearied. (Dr. Foster read the budget as 
recommended by the Council.) 

BUDGET, 1939-1940 


President’s Expenses $ 300.00 

Salaries 

Secretary-Treasurer 1,200.00 

Assistant Secretary 1,500.00 

Office Expenses 

Secretary-Treasurer 300.00 

Portland Office 600.00 

Committees 

Medical Advisory 500.00 

Graduate Education 500.00 

Other Committees 300.00 

State Delegates and Council 200.00 


Volume Thirty , No. 9 


Proceedings at the Eighty-Seventh Annual Session 


235 


Delegate, A. M. A. Annual Session 250.00 

Annual Session 200.00 

Clinical Session 200.00 

Appropriation to Journal ($2,000.00) 

Editor’s Salary 1,000.00 

Journal Expenses 1,000.00 


Total $8,050.00 


Dr. Foster: I have the figures for last year, and 
if there are any questions these figures can be 
read. The total — excuse me, Mr. Chairman, but 
the total is Eight Thousand Fifty Dollars. 

Chairman Pratt: You have heard the report of 
the Chairman of Council on the budget. What 
action will you take on that? 

Dr. Samuel H. Kagan, Augusta: Mr. Chairman, 
do I understand that this is the budget for 1939-40? 

Chairman Pratt: Yes. 

Dr. Kagan: You stated 1938-39. 

Chairman Pratt: If I stated it. I am wrong. 

Dr. Foster: If I stated it, I am likewise wrong. 

Dr. Wallace E. Webber, Lewiston: Mr. Chair- 

man, from the budget there, do I understand the 
Journal expenses are approximately Four Thou- 
sand Dollars? It is in four items, isn’t it, or three 
items? 

Dr. Foster: The Council recommends that the 
Journal have Two Thousand Dollars. 

Dr. Webber: Yes, but were there two other 

items? 

Dr. Foster: The Editor has One Thousand and 
the Journal itself has a thousand. 

Dr. Webber: That makes — 

Dr. Foster: Sorry I misled you. The Editor’s 
salary is one thousand and the Journal one thou- 
sand. The thousand dollars is to cover any deficit. 
The thousand dollars is property. 

Dr. Webber: Might I ask what the income is 

expected to be for the year? 

Dr. Foster: From the Journal? 

Dr. Webber: No, not the Journal; the Society’s 
income. 

Chairman Pratt: It is printed in the Journal 
on the last page. 

Dr. Frederick R. Carter, Augusta, Secretary- 
Treasurer of the Maine Medical Association: It is 
in the Auditor’s report. 

Dr. Webber: I ought to have known it, then, 

after reading it. 

Chairman Pratt: I might say that the total 

expenditure is $9,992.59. I might say we came out 
somewhat ahead this year in finances. I couldn’t 
remember exactly. If anybody is interested to 
know, we will call on the Treasurer. 

Dr. Kagan: Mr. President, I would like a little 
elucidation for the appropriation of $500 for your 
graduate study. What does that usually go to? 

Chairman Pratt: Dr. Foster will explain. 

Dr. Foster: As Chairman of the Council, I can 
report to you the discussion held at the Council 
meeting. The Committee thought they might need 
$500 last year to carry out their program which 
we understood was to have speakers come to Maine 
in various parts of the state, most likely in the 
rural communities, and give courses in medicine 
of one kind or another. It was thought that $500 
would cover all those expenses. As it happened, 
the program was not inaugurated and that money 
was not spent. But the plan of the Committee has 
been to have some medical education by young 
men and pay the expenses of the men who give the 
post graduate medical education out of that $500. 


A Member: Can you give us any information of 
the cost for last year of that same thing? 

Dr, Foster: The Committee on Medical Educa- 
tion spent $55.80. It was appropriated at their 
request because they had formulated the policy of 
having some speakers or teachers come into the 
state and give some lectures or give some courses; 
but it didn’t get going in time to carry it out. 

Dr, Kagan: Might I ask as to what happened to 
the difference between the $55.00 and the $500 that 
was appropriated? Did that go back to the treas- 
ury? 

Dr. Foster: No, that is still in the treasury. It 
never went out. 

Dr. Henry C. Knowlton, Bangor, Member Legis- 
lative Committee: Mr. Chairman, may I move the 
Council budget be accepted by the House of Dele- 
gates. 

This motion was duly seconded by several of the 
members present and was carried. 

Dr. Jackson: Mr. Chairman, I am not a mem- 

ber of the House of Delegates, but I would simply 
like to answer one or two questions that have 
been asked, in the absence of Dr. Hill, Chairman 
of the Graduate Committee. That $500 was appro- 
priated to be used as we saw fit, if and when the 
Secretaries of the County Societies asked us to 
furnish speakers, as they wished them. The plans 
of the Committee, unfortunately, were in a formu- 
lative state and w r e began to develop discussions 
and as yet we did not import very many men. 

There were a few men came in who came 
through the County Societies, and their expenses 
were taken care of. The Committee is able to re- 
port the very small amount that is expended sim- 
ply from the fact that a great many of the men in 
the state assumed their own expenses for a great 
many things, and a great many things were done 
in the Journal office; that is, printing of the vari- 
ous personal discussions and things for which the 
Society didn’t have to pay anything out of that 
money. 

But we do feel that $500 is the minimum amount 
which we would like to have at our disposal so 
that during the coming winter we can, at the re- 
quest of the various County Societies, furnish 
them with speakers well known and well versed in 
their subjects, on special subjects. That is the 
idea of having that money at our disposal. 

Chairman Pratt: Thank you. Dr. Jackson. This 
plan simply hasn’t gone into operation yet. It is 
still in formation. 

Dr. Jackson: No, it is still in the formulative 
state. We have some very valuable programs in 
progress, we have some very valuable, helpful men. 
Dr. Hill will be here by and by; Dr. Gottlieb is 
here now; probably Dr. Nickerson will be here, 
and we will have a committee meeting and per- 
haps at the next session of the House of Dele- 
gates we can give you something fairly definite 
that we will lay out for the individual members 
and for the Society through its County organiza- 
tions as a unit during the coming year. 

Chairman Pratt: The next article of business 
is the report of our delegate to the American 
Medical Association, Dr. Ellingwood. 

Dr. William A. Ellingwood, Rockland, Delegate 
to the American Medical Association: Mr. Chair- 
man and members of the House of Delegates: The 
ninetieth annual session of the American Medi- 
cal Association was held in St. Louis, Missouri, 
May 15 to 19, 1939, with headquarters located at 
the Statler Hotel. 

(Dr. Ellingwuod then read his report of that 
meeting.) * 

* Published in the July, 193 9, issue of the Journal, 
page 177. 


236 


The Journal of the Maine Medical Association 


Chairman Pratt: You have heard the report 
of our delegate to the American Medical Associa- 
tion. What action will you take? 

A Member,: I move it be accepted. 

This motion was duly seconded and carried. 

Chairman Pratt: The next business is the re- 
port of the delegates to our neighboring New Eng- 
land States. I may say that I had the pleasure of 
being the delegate to New Hampshire, and I had 
a very enjoyable time. They met in Manchester, 
where they hold their meetings every year. They 
had their one hundred and forty-eighth annual 
meeting, which makes them 61 years older than 
we are. They conduct their meetings in a good 
deal the same manner as we do. They have con- 
ferences, and the papers in the afternoon. 

I was much interested in one resolution passed 
by their House of Delegates, which I won’t read, 
but it condemned the Wagner Act, with which I 
agree most heartily. I had the pleasure of hearing 
Dr. Rock Sleyster, President of the American 
Medical Association. He talked on the Wagner 
Health Act and it was a magnificent edit. I wish 
we had him with us. I expect Dr. Fishbein will do 
as well. I had a very nice time. 

The delegate to Massachusetts, Carl M. Robin- 
son. Is Dr. Robinson present? (No answer.) 

The delegate to Rhode Island, Dr. Campbell, will 
report tomorrow. 

The delegate to Connecticut, Dr. Eugene O’Don- 
nell, Portland. Is Dr. O’Donnell present? (No 
answer. ) 

The delegate to Vermont, Foster C. Small of 
Belfast; he is not here, either. We will have to 
have these reports later. 

The next article of business is the report of the 
Standing Committees, which are not published in 
the Journal. Those that are published, it isn’t 
necessary that they be given here. The report of 
the Public Relations Committee, George R. Camp- 
bell, M. D„ of Augusta; he is not here today. 

Committee on Social Hygiene, E. S. Merrill of 
Bangor. Is Dr. Merrill present? (No answer.) 

Committee on Nursing Affairs, by Dr. Bryant. 
Dr. Bryant, I understand, is sick and is unable to 
be here. 

Tuberculosis Committee, George E. Young of 
Skowhegan. He is not here. 

Committee on Investigation of Collection Agen- 
cies, Dr. Geliring, Portland, reports there have 
been no inquiries this year, therefore there is no 
report. 

Committee on Problems of Health Insurance 
and State Medicine, Dr. Kershner, from Bath. Dr. 
Kershner remarked — I guess I will let him tell 
about it himself. 

Dr. W. E. Kershner, Bath, Chairman Committee 
on Problems of Health Insurance and State Medi- 
cine: Go ahead, you do the talking. 

Chairman Pratt: I was going to say I thought 
Dr. Kershner last year remarked that this com- 
mittee should be combined with the Graduate Ed- 
ucation Committee, and if I remember right no 
action was taken. I think we will call on Dr. 
Kershner just the same. 

Dr. Kershner: Mr. Chairman, the committee 

appointed met within two or three weeks after 
the Annual Meeting and decided that in view of 
the fact that we had completed the work that we 
were originally appointed for, and in view of the 
fact that there were still uncertainties existing 
abroad, that we sit tight for the time being. 

The Chairman of the Committee did report to 
the Secretary of the American Medical Associa- 


tion that we had conducted a survey and then 
stated or reported the elements of that survey to 
him, for which he received the thanks of the cen- 
tral office. There is nothing further. 

Chairman Pratt: Thank you, Dr. Kershner. For 
the Committee of Representatives of Appointed 
Hospital Staffs, M. C. Moulton, of Bangor, will re- 
port. Is Dr. Moulton here? (No answer.) I don’t 
know what other members were on that commit- 
tee. If there are any we might hear from them. 
(No answer.) 

Committee on Maternal Welfare, Roland B. 
Moore of Portland. Dr. Moore is not here. 

Dr. Ellingwood has a matter that he would like 
to bring up at this time. 

Dr. Ellingwood: Mr. Chairman and members; 
In connection with this Committee on Maternal 
Welfare, we have with us today Dr. Weaver who is 
here in connection with the American Committee 
on Maternal Welfare, Incorporated, consisting of 
representatives of several well-known institutions, 
and I think we would like to listen to Dr. Weaver 
just a few minutes. It is a pleasure for me to 
present to you, Dr. Weaver of Philadelphia. 

Dr. Ruth Hartley Weaver, Philadelphia, Pa., 
representing the American Committee on Mater- 
nal Welfare, Inc.: Mr. Chairman, I will just take 
a few minutes of your time because tomorrow you 
will see the motion pictures of “The Birth of a 
Baby” which were produced under the auspices of 
the American Committee on Maternal Welfare. 

I have prepared a map here which shows the 
states marked in yellow where the picture is now 
being shown. Besides that there are eleven other 
states offered where the picture has been ap- 
proved by the State Medical Society. It was a 
ruling of the American Committee on Maternal 
Welfare that it should be shown nowhere before 
it was approved by the State Medical Society, and 
I believe this is the first opportunity that Maine 
has had to vote on whether the picture shall be 
shown in the general motion picture houses 
throughout Maine. 

As you know, there is a great deal of value in 
visual education, and there are a great many ma 
ternal deaths unnecessary. General surveys have 
shown at least half, and in some places two-thirds, 
of the maternal deaths could be prevented; and of 
those preventable deaths, about half are attribu- 
table to the mother. And it is usually through her 
ignorance in not knowing what good maternal 
care is, which causes her death. 

Now this picture was produced primarily to re- 
duce unnecessary maternal deaths. Of course in- 
fant deaths in the early stages are closely asso- 
ciated with maternal care. This picture does just 
that thing. It shows what the mother should ex- 
pect in maternal care. It is just a medical sound 
picture, which could give offense to no one. It 
has been approved by all types of organizations, 
and I would like to have you view it tomorrow and 
vote on it when you do take up the matter, consid- 
ering that it can save some lives of mothers. 

Now in Maine the maternal death rate is not 
enviable. I think you have some forms here which 
show the death rate in Maine since 1915. You will 
notice that it isn’t one of the best states, because 
the last official rate that I have is 6.6 per thousand 
live births. So you see there is still much work 
to be done in Maine in regard to maternal mor- 
tality. 

Now there are certain restrictions which this 
Committee on Maternal Welfare place around the 
picture. In the first place, it is a feature picture. 
No other featured film can be shown, and the short 
films must be approved by the American Commit- 


Volume Thirty, No. 9 


Proceedings at the Eighty-Seventh Annual Session 


237 


tee on Maternal Welfare. There should be no com- 
mercial hook-up, no advertising that is not ap- 
proved. The general price of the theatre shall not 
be raised when this picture is shown. So there is 
no reason why it cannot be produced carefully 
and under good auspices throughout the state of 
Maine. I thank you. 

Chairman Pratt: As I understand it, Dr. Weav- 
er, you would like to have the approval of the 
House of Delegates? 

Dr. Weaver: I would. 

Chairman Pratt: For showing tomorrow after- 
noon? 

Dr. Weaver: No, to be shown throughout the 

state. 

Chairman Pratt: To be shown throughout the 
state? 

Dr. Weaver: Yes. 

Chairman Pratt: It will be shown here tomor- 
row afternoon anyway? 

Dr. Weaver: At five o’clock, or five-thirty. 

Chairman Pratt: You see, this American Com- 
mittee on Maternal Welfare consists of represen- 
tatives of the American Association of Obstetri- 
cians, Gynecologists, and Abdominal Surgeons, 
American College of Surgeons, American Gyneco- 
logical Society, American Hospital Association, 
American Protestant Hospital Association, Section 
on Obstetrics and Gynecology of the American 
Medical Association, American Nurses’ Associa- 
tion, American Public Health Association, Catho- 
lic Hospital Association, and a lot more. Does 
anyone wish to make a motion in regard to this? 

Dr. C. W. Kinghorn, Kittery, Secretary York 
County Society: Mr. President, it being the fact 

that this is approved in practically every state in 
the Union with a few exceptions, I make a mo- 
tion that this Association go on record as ap- 
proving the picture. 

A Member: Mr. President: I rather feel that 

before we approve it, we should see it; I don’t 
think we should approve things too blindly. The 
picture is here and it is a question of one day 
when we can see it, and I think it would be much 
more advisable to have the delegates view it and 
know what they are talking about. 

Dr. Kinghorn: I have seen it. 

A Member: I haven’t. 

Dr. Carl H. Stevens, Belfast, Councilor Fourth 
District: Last fall I saw this film at the American 
Surgeons’ Meeting in Chicago. It was presented 
late one afternoon and the following evening in 
the theatre, so the members of the College might 
approve or disapprove whether it should be shown 
publicly. If a time could be arranged, I think that 
might meet with the approval of the delegates. 

Chairman Pratt: Dr. Kinghorn’s motion is be- 
fore the house. I haven’t heard it seconded. 

Dr. Kinghorn: The time this picture is going 
to be shown is during the meeting, and we will 
have opportunity to see the picture. 

Dr. Weaver: May I suggest that Dr. Moore was 
here this morning and he requested that it be 
shown about 11.30 tomorrow morning if that were 
possible, because that would be at the end of the 
morning session and then the luncheon meeting 
after that could be arranged. 

Chairman Pratt: How long does it take? 

Dr. Weaver: Seventy minutes. 

Chairman Pratt: Is Dr. Cobb here? 

Dr. Stephen A. Cobb, Sanford, Chairman Scien- 
tific Committee: I don’t think it is a good time to 
show it, that is all. It fits in with the program the 


best tomorrow night after the Scientific session. 
Of course the House of Delegates can see part of 
it before they go into session. I don’t know any 
reason why they shouldn’t vote on it at that time. 
Tomorrow noon we have the meeting of reunion 
classes and they come at the noon hour, and there 
are a lot of fellows in the golf tournament and we 
do want to get all the ladies present possible to 
see this. I would rather see it shown tomorrow 
night at five o’clock, if possible. And I don’t 
see any reason why we couldn’t approve or dis- 
approve of this picture. There is only one state in 
the Union that has disapproved of it for public 
showing. 

Dr. W. N. Miner, Calais, member Legislative 
Committee: Mr. President, is there any reason 

why this picture couldn’t be shown tonight for us? 

Dr, Cobb: The only reason is that this is a 

sound picture and they have to have the operators 
out from Portland to put it on. It is brought out 
here at expense of the Association, and it will 
have to be put on tomorrow on its schedule at five 
o’clock tomorrow night. I might be able to put 
it on at eleven-thirty tomorrow, but it doesn’t fit 
in with the program. 

A Member: Mr. Chairman: My point of view is, 
Dr. Kinghorn and Dr. Stevens have both se.en it 
and both think it should be shown; I would be in 
favor of moving that it be shown publicly. 

Chairman Pratt: Do you wish to second Dr. 
Kinghorn’s motion? 

Member: Yes. 

Dr. Foster: Mr. Chairman, in adding my testi- 
mony to Dr. Kinghorn’s and Dr. Stevens’, it was 
shown at the N. E. Pediatric Society meeting at 
the Copley Plaza Hotel in Boston and it was ap- 
proved by them. That is simply more testimony 
in its favor. 

Chairman Pratt: All those in support of Dr. 

Kinghorn’s motion that the picture may be 
shown publicly in Maine, please raise their right 
hand. Those opposed? 

Chairman Pratt: Upon a hand-raising vote, 

the motion was carried. 

I think that Dr. Wallace Webber has a matter 
he would like to bring before the House. 

Dr. Webber,: Mr. Chairman and members: The 
Androscoggin Society held a meeting of the asso- 
ciation this winter and instructed every delegate 
to report to the delegates here in regard to two 
things. The first one is in regard to the telephone 
company charging business rate to the physician 
having an office in his home. Possibly all of you 
noticed that the New York physicians carried on 
quite a battle and finally won out, that they should 
pay a minimum house rate instead of a business 
rate in instances where they had an office in their 
home. 

On investigation I think we found that the New 
York Public Utilities Commission had ruled in 
their favor, and our Public Utilities Commission 
have made no similar ruling. I don’t know just 
exactly what action would be called for in that, 
but it seems to me that it is one that would be 
investigated carefully before any definite action 
would be taken; and in that particular thing I 
would move that the Secretary of our Association 
investigate the possibilities of reducing the tele- 
phone rate to physicians having their offices in 
their homes. I would make that as a motion.* 

* Editorial Note : From this decision an appeal has 
been taken and a new trial has been granted and it is 
said that if the ruling is upheld by the higher court 
more than $2, 000, 000. 00 will have to be refunded to 
physicians in the territory involved. 


238 


The Journal of the Maine Medical Association 


Dr. W. H. Walters, Fairfield, President Somer- 
set County Society: I wish to second that motion. 

Dr. Webber: Of course if it is seconded it 

would be law. 

C ir airman Pratt: Who seconded it? 

Dr. Walters: Dr. Walters. 

Chairman Pratt: Dr. Walters of Fairfield sec- 
onds the motion. Will you make that motion in 
writing, Doctor? 

Dr. Webber: The motion is that the Secretary 
investigate the possibilities of the telephone com- 
pany’s reducing the telephone fee of physicians 
having their office in their home, from a business 
rate to a house rate or home rate. 

Chairman Pratt: The motion is made and sec- 
onded. Is there any discussion? 

Dr. J. C. Oram, South Portland: Mr. President, 
if I may say a word, before we go to the Public 
Utilities Commission with that, may I offer as 
an amendment before the committee meets with 
the Public Utilities, that the Committee get in 
conference with the officials of the telephone 
company. I understand that they are not particu- 
larly anxious to have that come before the Utili- 
ties Commission, and you may be able to do busi- 
ness without too much involvement. So that as 
an amendment 1 offer this: before the committee 
meet with the Public Utilities Commission in re- 
gard to telephone rates of doctors having offices 
in their homes, that the committee first get in 
touch with the officials of the telephone company 
to find out their particular attitude in the matter. 
If they are unfavorable to such a request, then 
I suggest that the committee be empowered to 
take up the matter with the Public Utilities Com- 
mission of Maine. 

Chairman Pratt: You have heard Dr. Oram’s 
amendment. 

Dr. Webber: He made that as an amendment 

to the motion? 

Chairman Pratt: He made that as an amend- 

ment to the motion. Do you accept that amend- 
ment to your motion. Dr. Webber? 

Dr. Webber: I accept it, yes. 

Chairman Pratt: Dr. Webber accepts the 

amendment. You have heard Dr. Webber’s mo- 
tion as amended by Dr. Oram. Is there any further 
discussion? Do you accept the amendment, too, 
Doctor Walters? 

Dr. Walters: I accept it. 

Chairman Pratt: All in favor of Dr. Webber’s 
motion as amended by Dr. Oram, please raise your 
hands. 

Upon a hand vote the motion was carried. 

Dr. Webber: The other matter also had refer- 
ence to the telephone. In our telephone direc- 
tories the habit of the telephone companies is to 
put us down as doctors, which they do to the os- 
teopath, the chiropractor, and various other peo- 
ple who have a “doctor” attached to them, and 
they do not put down the “M. D.” 

It was moved by the Androscoggin County 
Medical Society that it was their desire that their 
names be booked in the telephone directories as 
M. D.’s, not merely as “Dr.”, but as M. D.’s. That 
seems to me a reasonable request. 

I would move that if it is the mind of the dele- 
gates here, our names be posted in the telephone 
directories with the appendix “M. D.” after them. 

Dr. Kagan : I think in other counties we are 

listed as “physicians,” and the others as “osteo- 
pathic physicians” or “chiropractic physicians.” 

I think it is a local thing; I think you could 
straighten that out. 


Dr. Webber: It is local? 

Dr. Kagan: I think so. 

Dr. Webber: Then it shouldn’t be of any impor- 
tance if it is local. 

Dr. Kagan: I think you could straighten it out, 
Dr. Webber, at home. 

Chairman Pratt: You have heard Dr. Web- 

ber’s motion; is the motion seconded? 

A Member: I second the motion. 

Dr. Kagan: I think Dr. Webber wants to with- 
draw his motion in view of the information given. 

Dr. Webber: If it is local. 

Dr. Kagan: I think it is local. In Augusta we 
are listed as “physicians” and “osteopathic physi- 
cians.” 

Dr. Webber: If it is local in Androscoggin Coun- 
ty — I don’t think we knew it was local. 

Chairman Pratt: Do you wish to withdraw the 
motion? 

Dr. Webber: I withdraw the motion. 

Chairman Pratt: Dr. Webber and the Doctor 
who seconded it, withdraw the motion. Before I 
call on Dr. Carter, I think that Dr. Hill has some- 
thing that he would like to present to us. Do you 
have anything you would like to bring out, Dr. 
Hill, at this meeting? 

Dr. Frederick T. Hill, Waterville, Chairman 
Committee on Graduate Education: Dr. Pratt, you 
have in mind what I wrote you about? 

Chairman Pratt: Yes. 

Dr. Hill: It is on the matter of Public Rela- 
tions. The point, gentlemen, is this. . . . 

Chairman Pratt: Dr. Hill, I would like to see 
a resolution introduced that this committee be 
given funds to work with, pursuant to the author- 
ity or endorsement of the Council, and that will 
give you a break on the committee. Let the Coun- 
cil allocate funds for this purpose. Do you make 
a motion? 

Dr. Hiix: I can’t, I am not a House Delegate. 

Dr. Kinghorn: I will make that motion. 

A Member: I will second the motion. 

Chairman Pratt: A motion has been made and 
seconded. Will you repeat the motion. Dr. King- 
horn ? 

Dr. Kinghorn: Well, I think perhaps you had 

better let him make the motion. 

Dr. Hill: Well, I suggest that the Council be 
given the authority to expend funds for use of the 
Public Relations Committee, as they see fit. 

Dr. Kinghorn: That is the motion. 

This motion was duly seconded and carried. 

Chairman Pratt: I think Dr. Carter has one or 
two matters that he would like to present at this 
time. 

Dr. Carter: Mr. President and members, this is 
a resolution brought by your President-Elect, Dr. 
Pratt, for the National Health Program, which is 
the Wagner Bill that is now being brought in Con- 
gress : 

“Resolved : That, in the opinion of the Maine 
Medical Association, the Wagner Health Act pro- 
poses a revolutionary change in the practice of 
medicine which is not justified by reliable evi- 
dence; that the cost of the proposed legislation 
would be tremendous and indefinite; that it is im- 
possible to amend the Act so as to make it work- 
able; that our Senators and Representatives in 
Washington be informed that the Maine Medical 
Association urges them to oppose the passage of 
the Act.” 


Volume Thirty, No. 9 


Proceedings at the Eighty-Seventh Annual Session 


23 9 


Chairman Pratt: You have heard the resolu- 
tion proposed. Perhaps it is needless to say I am 
in favor of it. I should think that the proper thing 
to do with this resolution would be to refer it to 
the Committee on Resolutions. 

Dr Foster: I so move. 

Chairman Pratt: Dr. Foster moves that the 

resolution be referred to the Committee on Reso- 
lutions. is the motion seconded? 

This motion was duly seconded and carried. 

Chairman Pratt: Dr. Hill, I think, has another 
report he would like to make. 

Dr. Hill: Last year a special committee was 

appointed by Dr. Bunker to confer with similar 
committees from the Maine Hospital Association 
and the Maine Nurses’ Association, to consider 
the problem of nursing education in Maine. This 
was a request committee. The following report is 
submitted : 

(Dr. Hill read the report of the committee re- 
garding nursing education in Maine.)* 

Chairman Pratt: That is the report of a com- 
mittee? 

Dr. Hill: Doctor, you have a copy of it? 

Dr. Carter: Yes, I have. 

Chairman Pratt: You have heard the report of 
Dr. Hill of the committee. What action do you 
take? 

Dr. Oram: I move that the report be accepted. 

This motion was duly seconded and carried. 

Chairman Pratt: Dr. Carter has another mat- 
ter. 

Dr. Carter: Mr. President and members: This 
is an amendment to Chapter VII, Section 4, of our 
by-laws as drawn up by Mr. Herbert Locke, our 
defense attorney in malpractice cases, and ap- 
proved by the Council in Session, June 28, 1938, 
at Bar Harbor. 

Chapter VII, Section 4. The Medical Advisory 
Committee shall consist of seven members and the 
Secretary. With the consent of the Council a ma- 
jority of the members of this committee shall be 
empowered to fill any vacancies that may occur 
upon that committee. It may assist in the defense 
of any member sued for alleged malpractice if the 
member was in good standing and had complied 
with the rules of the committee when the service 
on account of which the suit was brought was ren- 
dered. It may engage counsel, and may incur such 
expenses in the performance of its duties as may 
seem necessary, a final accounting to be made 
each year to the Council. 

Now here is the part that we want to change: 

“It may assist in the defense of any member 
sued for alleged malpractice if the member was in 
good standing and had complied with the rules of 
the committee when the service on account of 
which the suit was brought was rendered. It may 
engage counsel, and may incur such expenses in 
the performance of its duties as may seem neces- 
sary, a final accounting to be made each year to 
the Council.” 

Now he wants that changed so it reads like this: 

“It shall be concerned with the legal problems 
of physicians, particularly claims for alleged mal- 
practice. It shall seek to find and remedy the 
causes and conditions from which such legal 
problems, including malpractice, arise. Any mem- 
ber in good standing, accused of malpractice, may 
lay the accusation before such Committee and 
have the benefit of its advice. That the Commit- 
tee may advise soundly, it may engage counsel 

* Published in the July issue of the Journal, page 
183 . 


and incur such expense in the performance of its 
duties as may seem necessary, a final accounting 
to be made each year to the Council.” 

That is to be laid on the table and brought up 
tomorrow for consideration. 

Chairman Pkatt: This is an amendment. You 
have heard the amendment. Will somebody move 
that the matter be laid on the table and brought 
up tomorrow afternoon? 

Dr. Kagan: I so move. 

Chairman Pratt: Dr. Kagan moves that the 

matter be laid on the table and brought up to- 
morrow afternoon. Is the motion seconded? 

This motion was duly seconded and carried. 

Dr. Carter: I have a letter written from the 

New Brunswick Medical Society addressed to me. 
This is from their Secretary, A. S. Kirkland. 

(Dr. Carter read the letter just referred to.) 

A Member: 1940? 

Dr. Carter: No, this is 1939. 

Chairman Pratt: No action is needed on this 
communication. 

Dr. Foster: Mr. President, while no action is 

needed, it seems to me it might be courteous to 
read that invitation before the general session, to 
the full gathering or the full membership, at some 
meeting. 

Chairman Pratt: Do you make that as a mo- 
tion, Dr. Foster? 

Dr. Foster: As I understood, the invitation was 
to any and all members of the society? 

Dr. Carter: Yes. 

Dr. Foster: I move, then, that it be read to the 
full meeting of the Society. 

This motion was duly seconded and carried. 

Chairman Pratt: I am sorry to say that Dr. 

Bliss has just notified me that he is obliged to 
return home, and he is Chairman of the Nominat- 
ing Committee. I will appoint Dr. Forrest B. 
Ames, of Bangor, in his place as Chairman, and I 
will select another delegate from the Fifth District 
to take Dr. Bliss’ place. I am very sorry that you 
have got to go, Doctor. 

Dr, R. V. N. Bliss, Bluehill, Councilor Fifth 
District: So am I. 

Chairman Pratt: I would like to say that we 
ought, at some meeting, to have Mr. Locke present 
to give us a brief resume of the legal acts, or what- 
ever it is, of the Association during the past year. 
I will say that in my opinion, although Mr. Locke 
kept in the background as a matter of policy, I 
think he did some most excellent work in the 
Legislature this year. We hope to have him at 
some other meeting. 

Does any member have any other business they 
would like to bring up? 

Dr. Cobb: I would like to say at eight-thirty or 
thereafter this evening, in this room, we will have 
an entertainment that will be something different, 
and I can assure everybody present that the doc- 
tors and wives and guests are invited, and they 
will be treated to something very rare. 

Chairman Pratt: Has any other member any 

business to come before this group? 

Dr. Knowlton: Mr. President, I would like to 
refer back to what we call pre-natal care coming 
up regarding your legislature thing. I believe you 
have a Publicity Committee as well as a Public 
Relations Committee and a Legislative Committee. 
In view of the new process and the new manner 
of attack, should there be any amalgamation or 
consolidation of the three committees, or do they 


240 


The Journal of the Maine Medical Association 


all function differently? The new matter, appar- 
ently, is going to be a matter of publicity. 

Chairman Pratt: I believe the Publicity Com- 

mittee is simply a kind of censor of what goes out 
from this meeting to the press. 

Dr. Knowlton: Mr. Chairman, I move we ad- 

journ. 

This motion was duly seconded. 

Chairman Pratt: It is moved and seconded we 
adjourn until five-thirty tomorrow afternoon. 

(Whereupon the meeting was adjourned at six 
forty-five o’clock in the afternoon.) 

SECOND MEETING OF THE HOUSE OF 
DELEGATES, JUNE 26, 1939 

The second session of the House of Delegates 
convened on Monday, June 26, 1939, at 5.30 p. m„ 
with Dr. George L. Pratt of Farmington, President- 
Elect of the Maine Medical Association, presiding. 

Chairman Pratt: The Secretary will call the 

roll. 

(The Secretary called the roll and the following- 
delegates responded): 

Androscoggin County: W. E. Webber, Lewiston. 

Aroostook County: H. E. Small, Fort Fairfield. 

Cumberland County: L. A. Brown, W. D. Ander- 
son, Ralph A. Heifetz, D. H. Daniels, Portland; 
.1. C. Oram, South Portland. 

Franklin County: C. C. Weymouth, Farmington. 

Hancock County: M. A. Torrey, Ellsworth. 

Kennebec County: Samuel H. Kagan, Augusta. 

Knox County: Howard Apollonio, Camden; A. .1. 
Fuller, Pemaquid. 

Oxford County: E. M. McCarty, Rnmford. 

Penobscot County: L. ,1. Wright, Henry C. 

Knowlton, Forrest B. Ames, Bangor. 

Piscataquis County: F. J. Pritham, Greenville 

Junction. 

Sagadahoc County: A. F. Williams, Togus. 

Somerset County: W. H. Walters, Fairfield. 

Waldo County: Foster C. Small, Belfast; Carl 

H. Stevens, Belfast, Alternate. 

York County: S. A. Cobb, Sanford. 

Chairman Pratt: We have a sufficient number 
to do business. I would like to ask you again when 
you speak, unless you are called upon by name, to 
state your name when yon get up. It helps the 
reporter. We always say that and then no one 
does it. I think it would he a good idea if you 
did do it. 

The first article of business is the Report of the 
Nominating Committee; Dr. Forrest B. Ames of 
Bangor. 

Dr, Forrest B. Ames, Bangor, Chairman Nom- 
inating Committee: Mr. President and Delegates: 
The Nominating Committee offer the following- 
names for the committees for 1939 and ’40: 

(Dr. Ames read the list of nominations for the 
various Standing and Special Committees.)* 

Dr. Ames: As delegate to the 1940 Session of 

the American Medical Association, we present the 
name of W. A. Ellingwood of Rockland. The Com- 
mittee further recommends that a suitable Alter- 
nate Delegate to the American Medical Association 
he appointed by the Council. Respectfully sub- 
mitted by the Committee on Nominations. 

Chairman Pratt: Dr. Ames, we think the A. 

M. A. delegates should be appointed for two years. 

* Published in the July, 1939, issue of the Journal, 
page 182. 


Dr. Ames: Two years? 

Dr. Carter: Two years; that is right, Doctor. 

Chairman Pratt: I think that is satisfactory. 

Dr. Ames: Yes, indeed. 

Chairman Pratt: Yon have heard the report of 
the Committee on Nominations. What will you do 
with it? 

A Member: I move the report he accepted. 

This motion was duly seconded. 

Chairman Pratt: It is moved and seconded 

that the report be accepted. 

Dr. Williams: I make a motion that the Secre- 
tary cast a ballot. 

This motion was duly seconded. 

Chairman Pratt: Did you make both motions, 
Doctor, or did you just add to the motion? 

Dr. Williams: Well, I understood his motion 

was to accept the report, and I amended it that 
the Secretary cast a ballot. 

Chairman Pratt: I will present the motion as 
amended and seconded. Is there any discussion? 

This motion was duly carried. 

Chairman Pratt: The Secretary will cast a bal- 
lot for the Committees elected. Dr. Hill has a mat- 
ter he would like to present at this time. 

Dr. Hill: Mr. Chairman and members of the 

House of Delegates: The Committee on Graduate 
Education this year presented a recommendation 
in the report as published in the Journal, to the 
effect that this Association actively participate in 
the New England Post Graduate Medical Assembly. 
This is at the request of the original sponsoring 
body, the Massachusetts Medical Association. I 
had a conference with Dr. Ober over this and they 
are very anxious that the state associations come 
into this so they can make it purely a New Eng- 
land Post Graduate Assembly rather than a Massa- 
chusetts creation alone. 

Therefore, your Committee has made this recom- 
mendation, and we would like to suggest the fol- 
lowing motion: That the Maine Medical Associa- 
tion participate as an organization in the New 
England Post Graduate Medical Assembly, and 
that the Committee on Graduate Education he au- 
thorized to act for the Association in matters re- 
lating to said New England Post Graduate Medical 
Assembly. 

Dr. C. C. Weymouth, Farmington: I make the 
motion that the motion of Dr. Hill he made and 
seconded. 

This motion was duly seconded by Dr. Knowl- 
ton, and carried. 

Chairman Pratt: The next article of business 
is the report of the Reference Committee, by the 
Chairman, Dr. P. L. B. Ebbett of Houlton. 

Dr. P. L. B. Ebbett, Houlton, Councilor from the 
Sixth District: The following resolution has been 
handed to the Reference Committee: 

“That, in the opinion of the Maine Medical As- 
sociation, the Wagner Health Act proposes a revo- 
lutionary change in the practice of medicine, 
which is not justified by reliable evidence; that 
the cost of the proposed legislation would be tre- 
mendous and indefinite; that it is impossible to 
amend the Act so as to make it workable; that our 
Senators and Representatives in Washington he 
informed that the Maine Medical Association 
urges them to oppose the passage of this Act.” 

Now the Reference Committee believes that this 
resolution should be adopted by the Maine Medical 
Association. 

Chairman Pratt: You have heard the recom- 

mendation. Do you make that a motion. Doctor? 


Volume Thirty, No. 9 


Proceedings at the Eighty-Seventh Annual Session 


241 


Dr. Ebbett: I would make a motion that the 

Maine Medical Association adopt that resolution 
as read. 

This motion was duly seconded by Dr. Webber. 

Chairman Pratt: You have heard the motion 
which was seconded by Dr. Webber. Is there any 
discussion? 

Dr. Knowlton: Mr. Chairman, it seems to me 

that probably this Wagner Act will he passed 
whether we like it or not. And I am rather loath 
for us to send in any such resolution as that to 
our Senators and Representatives. In the first 
place I don’t think it will do any good, and in the 
second place I think it will be interpreted, espe- 
cially if it receives any publicity at all, that we 
are, however correctly, getting in the way of what 
is going to be taken as progress. 

Agreeing perfectly with the President-Elect that 
the Act isn’t justified, I think it is rather poor 
publicity to air our views at all in a public place, 
at least this year, and I don’t think it is going to 
do any good anyway. 

Chairman Pratt: Is there any further discus- 

sion. 

Dr. Foster: Mr. Chairman, may I ask to have 
the resolution reread? 

Chairman Pratt: I will ask Dr. Carter to re- 
peat the resolution. 

(Dr. Carter then reread the resolution.) 

Chairman Pratt: Do any other members wish 
to discuss this matter. 

Dr. Oram: I think our feeling in this matter is 
perfectly justified economically, and I think it is 
better for the patient to go the way things are, as 
they are. But Dr. Knowlton has brought out a 
point which people will certainly grab on and hang 
onto like a dog to a hone. 

I think we could get much more action from our 
Representatives and Senators in Washington if the 
medical men would write to them, and the Lord 
knows they won’t do it because they feel they can’t 
waste their time looking out for their own for- 
tunes, which will soon become misfortunes. 

Dr. Elungwood: Dr. Oram said a mouthful. 

This has been before the committee on May 25. 
We sent a committee from the American Medical 
Association down to Washington and if you have 
read your Journals you have seen what has gone 
on. Now I believe what Dr. Oram has said is really 
better than any resolution we could pass as an 
organization. 

Now I will tell you why I think so. It is from 
the experience we have had in our own Legislature 
in regard to the hills that the osteopaths have 
entered, whereby every osteopath has written a 
letter, and they have had their clients or their 
patients write in to their Representatives. And 
the medical man, as Dr. Oram said, either doesn’t 
know how to write or hasn’t had the time. 

I doubt very much if this resolution would he of 
any great benefit, but I do believe that if we, as 
representatives of this organization, would write 
to our Senators and Representatives, it might have 
considerable hearing. That might be well to con- 
sider before we pass on it. 

Dr. Foster: The report of the Council, you may 
remember, instructed the Chairman to communi- 
cate with the Senior Senator of this State and 
present the views of the Society on the National 
Health Act. That was done, and in consultation 
with Mr. Hale I found that he, as Senior Senator, 
was against the Act and expected the whole Maine 
delegation would he against the Act. Of course, he 
was not in a position to make any pledges or com- 
mitments for the other members of the Maine 


delegation, but he did tell me that he felt they 
were distinctly against it. 

I am inclined to agree with Dr. Knowlton and 
Dr. Oram, that any resolution from this organiza- 
tion may antagonize the public more than it will 
aid the defeat of the measure. I should favor 
simply consideration of the resolution, and if the 
delegates decide to pass such a resolution I would 
favor modifying it to the extent of qualifying it 
in its present form. 

My point is, as I think Dr. Knowlton expressed 
it, that strategy such as that resolution is not as 
effective as individual expression of opinion. 

Dr. Hill: Mr. President, may I have the floor 
for a few minutes? 

Chairman Pratt: You may. 

Dr. Hill: This resolution will be in awfully 

good company, because a number of other large 
organizations are doing the same thing. And prob- 
ably the one man who is going to do more to kill 
this Wagner Bill when it is killed, is the head of 
the Catholic Hospital Association, who has come 
out emphatically against it; and you notice the 
odds in Washington are now eight to two against 
the Wagner Bill being passed. 

I feel perhaps this is as effective as anything. 
I certainly feel the Association should protest 
against it; but wouldn’t it be very effective for the 
President of the Association to communicate, as 
President, personally with each member of the 
delegation, saying it is the view of the Maine 
Medical Association that the bill be not passed. 
The protest is not bad. 

Chairman Pratt: Is there any other discus- 

sion? 

Dr. Webber: Mr. President, I wonder if the 

politics of Washington would he like the politics 
of the State in the matter of opposition to the 
medical profession? 

In the first place, this bill is a social bill. AVhile, 
of course, it primarily affects the doctors, it is not 
in its text aimed at the doctors. It is more par- 
ticularly aimed at the social condition, and to 
improve, as the argument goes, the condition of 
the laity. It seems to me that a protest of this 
kind by the Association would do some good. I 
can't see why it should do harm. 

I can see how we, in our own State Legislature, 
always have been worse off by the doctors’ pro- 
testing these things than had we stayed at home, 
because they have thought it was professional 
jealousy. Now in this instance I can’t see that 
they could feel that it was professional jealousy 
and I should feel that a protest like this from the 
Association would do some good. 

I know, as well as you all know, that a political 
thing of that sort is carried on sub rosa more or 
less, and a good deal more than less, and that the 
protests of organizations as such do not weigh as 
heavily as individual protests do. But I can’t see 
where this would do any harm, and it certainly 
shouldn’t prevent any of us writing to our Legis- 
lator if we saw fit. I feel that the majority of us 
are too lazy to do it, but a few will, and it seems 
to me that this thing should go through. 

Dr. Knowlton: Mr. President, if I may state 

just a word? 

Chairman Pratt: Dr. Knowlton. 

Dr, Knowlton: Mind you, I am not in favor of 
the Wagner Act. We are, however, a small organi- 
zation, part of the American Medical Association. 
The American Medical Association, as you know, 
is under indictment; we don’t stand in at all as a 
group. If we sit down and write our protests as 
any voter has a right to do, to our Representatives 


242 


1 he Journal of the Maine Medical Association 


and Senators, we would carry some weight. If we 
send in a resolution, we do nothing but publicize 
ourselves if the bill is passed, or whether it is 
passed or not; we get ourselves out on the limb 
for our opponents to saw off the limb behind us. 
That is my point about it. 

Dr. Foster: Mr. Chairman, I would like to hear 
from the Chairman on this matter, if he feels will- 
ing to speak. 

Chairman Pratt: I was going to, if you will 

permit me to, after everyone else had spoken that 
wanted to. I would like to say that in my opinion, 
if we think this bill is wrong, we ought not to be 
afraid to say so. I think if we make individual 
protests they will be a good deal more effective, if 
we say that we have the opinion of our organiza- 
tion behind us. 

The New Hampshire State Society passed a sim- 
ilar resolution. They voted to instruct their dele- 
gates to either oppose or drastically amend the 
Act. Our resolution says it is impossible to amend 
the Act. In the testimony before the committee in 
Washington which is conducting the hearings now, 
and before which the American Medical Associa- 
tion is getting its first opportunity to have any- 
thing to say, it was said that three hospital associa- 
tions, and one of them was the American Hospital 
Association, had attempted to amend the hospital 
clause alone of this Act. After they had got up to 
fifty or more amendments, they quit. The Act is so 
long and so cumbersome and so involved that in 
my opinion it is impossible to amend it. 

I have great respect, as I said, for the opinion of 
the gentlemen who are afraid we might do some 
harm. I don’t believe we will do any harm. We 
will take the stand if we do, and we should. I 
hope the resolution will pass. 

Is there anything further at this time? 

Dr. A. J. Fueler, Pemaquid, Secretary Knox 
County Society: Mr. Chairman, in a case like this 
where Dr. Fishbein is going to be present to- 
morrow and the delegates are not meeting after 
his presence here, would it be possible if Dr. 
Ebbett withdrew his resolution before the House 
of Delegates, to leave it to the Secretary or the 
Chairman of the House of Delegates to proceed as 
lie saw fit with this resolution after talking with 
Dr. Fishbein, to see whether it will be more ad- 
vantageous or not? 

Chairman Pratt: I think that might be pos- 

sible. 

Dr, Ralph A. Heifetz, Portland: Mr. President, 
I think perhaps it would be a little bit more tact- 
ful to pass that resolution before he did come 
down. I don’t know how many of you have read 
this report in the American Medical Journal, at 
least the last two Journals; but in view of Dr. 
Ebbett’s stand and Ex-Senator Hodge’s stand, I 
think Senator Wagner has shown a lot of persis- 
tence. 

In view of the Wagner Act not being amended, I 
think they felt that another Act written, or rather 
another National Health Act written another way, 
might be suitable to the American Medical Associa- 
tion. 

It makes you feel if we pass that resolution be- 
fore he came down, it might show him exactly 
where we stood on it. 

Dr. Ehbett: I might say this resolution is not 
one I proposed. This is not my resolution. I am 
merely Chairman of the Committee. That was 
passed to us for consideration, to the Reference 
Committee for consideration, believing that this 
Society should take some definite action and some 
definite stand. If it is left to individuals there 
will be a half a dozen letters which wouldn’t 


amount to much. But I believe this Society should 
stand behind this thing as a whole. Then if mem- 
bers will be so good as to write their Representa- 
tives, I think it will help the thing along very 
much. But if only a small proportion wrote, it 
wouldn’t amount to much. In my opinion there 
would be very few letters going to our Senators 
unless we take some action. 

Dr. Fuller: Mr. Chairman, I am heartily in 

favor of this resolution being sent in, but I didn’t 
know but what, owing to the discussion, it might 
be better if it were left to the discretion of the 
Chairman to do as he saw fit with the authority 
back of him, after talking with Dr. Fishbein about 
the advantages of it. 

Chairman Pratt: I don’t think anything will be 
done with the resolution anyway until after we 
talk with Dr. Fishbein. We will show him the res- 
olution, and if he advises us to keep it under cover 
we will do so. 

Dr. Kagan: Mr. President, there is another view 
on this line which in preliminary parleys is very 
important. If we do not pass any opinion on the 
matter, undoubtedly the followers of the bill will 
say, “Well, there is Maine; the doctors up there 
haven’t opposed the bill.” I think that is an atti- 
tude you must consider. We have got to go on 
record one way or the other. 

Dr, Weymouth: I quite agree that this bill or 
resolution should be passed, and I think we should 
express ourselves and not be afraid to do it. I 
think in addition to the Association expressing 
itself in opposition to the Wagner Bill, that each 
member still can write and exert their power in 
opposition to it. I firmly believe that we should 
do our part in opposition to the bill. 

Dr. Cobb: Question. 

Chairman Pratt: The question is called for. 

All those in favor of passing the resolution please 
raise their right hand. Those opposed? It is a vote. 

Dr, Knowlton: You had better make it unani- 
mous. 

Chairman Pratt: I will now ask for the report 
of the Delegates from the First District for nomina- 
tion of Councilor. Do you have any nominations to 
make from the First District for Councilor? 

Dr. Oram: Mr. President, I think the Medical 

Association elected a most excellent Councilor 
from our District, and we want somebody who 
will fill his shoes equally well. And the delegates 
from that District feel that Dr. Stephen A. Cobb 
will be an excellent man; therefore we place his 
name in nomination for Councilor of this District. 

A Member: Second the nomination. 

Chairman Pratt: The nomination is made and 
seconded that Dr. Stephen Cobb be Councilor from 
the First District. Any other nominations? If not, 
all those in favor of the nomination of Dr. Cobb 
please raise their hand. Opposed? (Applause.) 

(There was no opposition.) 

A Member: Speech! 

Chairman Pratt: Dr. Cobb is elected. If he is 
here we will call upon him for a speech. 

Dr. Cobb: Mr. Chairman, I haven’t any speech 
to make in being raised to this office, but I have 
something I would like to say. Two years ago we 
had Ken Roberts and the bogus doctor from the 
land of Italy, and last night we had a wonderful 
entertainment by Dr. Romano of New York City. 
All three of these speakers came to our Associa- 
tion meetings without a cent of expense to the 
Association, through the kindness of Jim Campbell 
who has no political aspirations, and I don’t think 
he will get much advertising for his Palm Beach 
cloth, sending them to our Association. He has 
done that for his friendship to me and love for 


Volume Thirty, No. 9 


Proceedings at the Eighty-Seventh Annual Session 


2U3 


the medical profession. He has always been sorry 
he wasn’t a doctor. He has always said after he 
made a million dollars he was going to study 
medicine. 

I think it would be a fine gesture for this Asso- 
ciation to send Colonel Jim a nice letter of thanks. 

Dr. Knowlton : I so move. 

This motion was duly seconded and carried. 

Chairman Pratt: I will say Councilors are 

elected to do a lot of work for nothing. And Dr. 
Cobb has demonstrated he is a good worker for 
the last several years. 

I will now ask for nominations for the Second 
District. 

Dr. Ames: The delegates would nominate Dr. 
McCarty of Rumford Falls. 

Chairman Pratt: Is the nomination seconded? 

Dr. Knowlton: Seconded. 

Chairman Pratt: Are there any other nomina- 
tions? All in favor of the election of Dr. McCarty 
as Councilor from the Second District, please sig- 
nify by saying “aye.” 

(There was a chorus of “ayes” and the motion 
was carried.) 

Chairman Pratt: It is a vote, and Dr. McCarty 
of Rumford is elected Councilor of the Second Dis- 
trict. If he is here I think he ought to make a 
speech. 

Dr. E. M. McCarty, Rumford: Mr. President, I 
am not a speech-maker, but I will say this. I will 
try to put a little time in, and tag along as best I 
can. (Applause.) 

Chairman Pratt: There are several delegates 

to other societies who were not present yesterday, 
and I call on the delegate to Massachusetts, Carl 
M. Robinson. 

Dr. Carter: Mr. President, Dr. Robinson was 

called away about half an hour ago, and he wished 
me to say to you and the members that he at- 
tended the meeting in Massachusetts. He was 
royally entertained and enjoyed it very much, and 
he thanks us for sending him. 

Chairman Pratt: Delegate to Rhode Island, 

George R. Campbell. 

Dr. George R. Campbell, Augusta: Mr. Presi- 

dent, I want to thank the Association for sending 
me down there. I had a very enjoyable time. The 
meeting was held in the Rhode Island Library in 
Providence, which the Association owns, and they 
held clinics in the mornings of two days, and in 
the afternoons there were papers which took most 
of the afternoon. 

One of the highlights of the first day was a pa- 
per by Marshall Fulton, Associate of Medicine of 
Harvard Medical School. 

(Dr. Campbell read a list of speakers and their 
subjects at the Rhode Island Medical Association 
meeting. ) 

In the morning clinics were held at the various 
hospitals, and in the evening of the last day the 
banquet was held. And last but not least, the 
speaker was Dr. Reginald Fitz. (Applause.) 

On the whole it was a very interesting and in- 
structive meeting. 

Chairman Pratt: Thank you, Dr. Campbell. 

The delegate to Connecticut, Eugene O’Donnell 
of Portland. 

Dr. Foster: Mr. Chairman, I talked with Dr. 

O’Donnell, who is a graduate of Yale Medical 
School, and was delighted to have an opportunity 
to attend a meeting of the Connecticut Medical 
Society. He reports he had a delightful time, was 
royally entertained as Dr. Carter said, and in 


every way pleased with having the opportunity of 
attending the meeting. 

Chairman Pratt: Delegate to Vermont, Foster 
C. Small. 

Dr. Foster C. Small, Belfast : Mr. Chairman and 
House of Delegates: I attended the Vermont Medi- 
cal Society meeting last fall and had a fine recep- 
tion. There was fine entertainment and I was well 
received. I was especially pleased to represent 
the Maine Medical Association, for which I thank 
you. 

The scientific sessions were all held in the Hotel 
Vermont, and the chief subject that was really a 
highlight of the entire session was the discussion 
of gall bladder diseases, giving the histology, 
pathology, physiology, medical, and non-surgical 
treatment, conducted by Dr. Gordon, I believe, of 
McGill University. It was well worth hearing, 
very instructive, and especially well presented. 

The other sessions were held in the main dining 
room of the Hotel Vermont in the evenings. We 
had a very fine banquet, and the closing session 
was more of a social occasion and was not a scien- 
tific program. We just had debaters and had a 
real fine, good time. And again I want to thank 
you for having the privilege of going. 

Chairman Pratt: Thank you, Dr. Small. That 
is an excellent report. 

There are two of the Councilors whose reports 
didn't get into the Journal in time to be printed, 
and I will call on Dr. Carl Stevens, if he has a 
report from his District. 

Dr. Carl H. Stevens, Belfast, Councilor from the 
Fourth District: Mr. President and Members of 

the Association: As Councilor of the Fourth Dis- 
trict, comprising Kennebec, Somerset and Waldo 
Counties, it is my privilege to report that during 
the last year all three Societies have been active. 
They have had many well-arranged and well-at- 
tended meetings. 

Two of the meetings I attended seemed to me to 
be unusually interesting, and they were furnished 
by two panel sections, one on pneumonia, the 
other on fractures. 

As you may know, Waldo County is a small 
county and has a small membership. But I asked 
Dr. Torrey, who is a live wire and I think measures 
up very well as a secretary, to give me a brief 
resume, and I really was surprised myself to find 
what we have done in that little comity in the last 
year. 

We have had joint meetings with Hancock and 
Knox Counties on some occasions. At the Sep- 
tember meeting Dr. Roland Moore of Portland and 
Dr. Mitchell of the State Bureau were present and 
gave a program on obstetrics. In November there 
was a joint meeting with Hancock County at Ells- 
worth, and the second part of this program was 
presented on obstetrics by Dr. Moore and Dr. 
Jewett. 

At the second meeting in Belfast, Dr. C. B. Pop- 
plestone spoke on Electrocardiography, and Dr. 
Philip Wood spoke on Vitamins and the results 
from some of them. Later a joint meeting of 
Waldo, Knox and Hancock was held at Belfast, 
and there the panel discussions were under the 
chairmanship of Dr. Allan Woodcock of Bangor. 

In April they had an A. M. A. sound picture on 
Syphilis, which was an unusually good program. 
We were able to put that on by procuring a sound 
moving machine from a Camden High School. 

All in all I believe that the Fourth District has 
had a very successful year. Thank you. 

Chairman Pratt: Thank you, Dr. Stevens. I 


244 


The Journal of the Maine Medical Association 


will call on the Councilor from the Second Dis- 
trict, Dr. Bolster. Dr. Bolster is not here. 

We have several committees whose reports were 
not published and the Chairmen were not here 
yesterday. I will call on Dr. George R. Campbell 
of Augusta for report on the Public Relations Com- 
mittee. Is Dr. Campbell here? He has just gone 
out. 

Committee on Social Hygiene, Dr. E. S. Merrill 
of Bangor. Dr. Merrill is not here. 

Dr. M. C. Moulton, Chairman of the Committee 
of Representatives of Appointed Hospital Staffs. 

Dr. Knowlton: He is not here. 

Chairman Pratt: Committee on Maternal Wel- 
fare, Roland B. Moore, Chairman. He is not here. 

Dr. Carter has a matter he would like to bring 
up. 

Dr. Carter: This is the amendment that was 
presented to you yesterday, laid over in that meet- 
ing, and is taken up today for your consideration. 
Amendment to Chapter VII, Section 4, of the By- 
Laws, presented by Mr. Locke and approved by 
the Council in Session June 28, 1938, at Bar Har- 
bor. It reads as follows: 

Chapter VII, Section 4. The Medical Advisory 
Committee shall consist of seven members and the 
Secretary. With the consent of the Council a 
majority of the members of this committee shall 
be empowered to fill any vacancies that may occur 
upon that committee. It may assist in the defense 
of any member sued for alleged malpractice if the 
member was in good standing and had complied 
with the rules of the committee when the service 
on account of which the suit was brought was 
rendered. It may engage counsel, and may incur 
such expenses in the performance of its duties as 
may seem necessary, a final accounting to be 
made each year to the Council. 

Now here is the part we want to change: 

“It may assist in the defense of any member 
sued for alleged malpractice if the member was 
in good standing and had complied with the rules 
of the committee when the service on account of 
which the suit was brought was rendered. It may 
engage counsel, and may incur such expenses in 
the performance of its duties as may seem neces- 
sary, a final accounting to be made each year to 
the Council.” 

Now he wants that changed so it reads like this: 

“It shall be concerned with the legal problems 
of physicians, particularly claims for alleged mal- 
practice. Tt shall seek to find and remedy the 
causes and conditions from which such legal prob- 
lems, including malpractices, arise. Any member 
in good standing, accused of malpractice, may lay 
the accusation before such Committee and have 
the benefit of its advice. That the Committee may 
advise soundly, it may engage counsel and incur 
such expense in the performance of its duties as 
may seem necessary, a final accounting to be 
made each year to the Council.” 

Mr. Locke was before our Council and explained 
last year, as I remember it, just why he wanted 
that change made. I don’t remember the particu- 
lars at this time. 

Chairman Pratt: I think we all agree that 

whenever Mr. Locke asks for a change, his rea- 
sons are good. 

Dr. Webber: I move we pass it. 

Dr. Knowlton: I second the motion. 

Chairman Pratt: Dr. Webber moves and Dr. 

Knowlton seconds the motion. 

This motion was duly carried. 


Chairman Pratt: The next article of business 
is an invitation to the 1940 Annual Session. I 
would like to say that this matter, as to time and 
place, has generally been left to the Council, but 
the House of Delegates has the power to decide 
now, if they wish to. I think Dr. Carter has an 
invitation, one or more, to read. 

Dr. Carter: This letter I received June 12, 1939, 
from Mr. Charles B. Day, the Manager of the 
Rangeley Hotel. It reads as follows: 

(Dr. Carter read letter of June 12, 1939, from 
Mr. Day.) 

Dr. Carter: I will say that he came to the hos- 
pital and interviewed me relative to the meeting 
next year, and I said, “The only thing that I can 
say, Mr. Day, is if you will send us your proposi- 
tion I will present it before the proper authority.” 

Dr. Weymouth: Mr. President, I think, since it 
has been the custom to leave this with the Coun- 
cil, (hat I would make a motion that it be left 
with the Council this year. Of course, we are 
doubly anxious to have it in Rangeley, and I 
think everybody knows what Rangeley has to of- 
fer, not only in the way of golf, but lake sports 
and what-not. No doubt they would choose that. 
I make a motion it be left with the Council. 

Dr. Webber: I second that motion. 

Chairman Pratt: The motion has been made 

and seconded that it be left with the Council. Is 
there any discussion? 

Dr. Kagan: Mr. President, is there any definite 
plan or idea as to successive places of meetings? 

I mean, do you go according to having the meet- 
ing, say, in District 1, 2, 3, 4, 5, 6? 

Chairman Pratt: No, there is no definite rule. 

Dr. Kagan: There is no possibility of having 

the whole state represented in sequence, then? I 
think that is a thing that the Council ought to 
take into consideration. 

Chairman Pratt: I think I ought to say to Dr. 
Kagan, there are only a few places in the State 
where they have places large enough. The Council 
voted, or the Association voted, several years ago 
to have these annual meetings at one of the sum- 
mer resorts: Poland Spring, the Marshall House 
at York Harbor, and the hotel down in Bar Har- 
bor, and Rangeley, are about the only ones that 
are large enough to accommodate the crowd. 

Dr. Kagan: That answers the question. 

Chairman Pratt: Does anyone else wish to dis- 
cuss the matter? If not, all those in favor of Dr. 
Weymouth’s motion please signify it. Opposed? 

(There was a chorus of “ayes” and the motion 
was carried.) 

Dr. Cobb: Mr. Chairman, your Program Commit- 
tee has tried hard this year to make it more or 
less interesting for the ladies. Now out there to- 
night at supper I have a big place laid out in the 
dining hall, and we are going to have dancing after 
the dinner. We have a fine orchestra, and I want 
you fellows to help me out and see that our ladies 
do not become wallflowers during the evening. 

And I want to say shortly after nine we have 
another fine speaker this evening, and if you en- 
joyed the show last night, I believe Dr. Greene 
will put on just as good a show tonight, and I will 
feel well repaid by your attending this session this 
evening. 

Chairman Pratt: Thank you, Dr. Cobb. I would 
like to say, we have with us one of our speakers 
of tomorrow afternoon, Dr. John J. Moorhead of 
New York, and I would like to have him stand up 
so you will all know who he is. (Applause.) You 


Volume Thirty, No. 9 


Proceedings at the Eighty-Seventh Annual Session 


245 


will probably bear all you want to from him to- 
morrow afternoon. 

Does any member have any new business he 
would like to offer? 

Dr. Foster: Mr. Chairman, before we adjourn 
I would like to report that Mrs. Kennard asked 
me to tell the Council to remain in this room after 
the meeting. It may be you were going to ask 
that, anyway. Mrs. Kennard asked me to remind 
you. 

Chairman Pratt: I thank you, I had forgotten 
it. The Council will meet here to organize? 

Dr. Foster: That is right. 

Chairman Pratt: If there is no other new busi- 
ness, a motion is in order to adjourn. 

A Member: I move we adjourn. 

This motion was duly seconded and carried. 

(Whereupon, the meeting adjourned at six- 
twenty o’clock in the evening.) 

ELECTION OF THE PRESIDENT-ELECT 

The meeting convened on Monday, June 26, 1939, 
at five five p. m., with Dr. Willard H. Bunker, 
President of the Maine Medical Association, pre- 
siding. 

President Bunker: Will you come to order, 

please? 

Dr. Carter: Please be seated. 

President Bunker: Gentlemen, nominations for 
President-Elect of this Association are in order. 

Dr. Philip P. Thompson, Portland: Mr. Presi- 
dent, it gives me great pleasure to nominate Dr. 
Thomas Foster, Portland, for President-Elect. He 
comes from a line of well-beloved physicians. His 
father was President, I think, of this Association 
in 1909, and he has served several years on the 
Council, so he is not only well-liked but well-fitted 
for the office. 

Dr. W. E. Kershner, Bath: Mr. President, it 

gives me great pleasure to second the nomination 
of Dr. Thompson. I have known Dr. Foster for a 
number of years and I have known him fairly in- 


timately under certain conditions, and I assure 
you gentlemen in honoring him the Society is hon- 
oring itself. I second the nomination. I move that 
the nominations cease and that the Secretary cast 
a ballot for Dr. Foster. 

President Bunker: Gentlemen, you have heard 
that nomination; all those in favor of the motion 
will please say “aye.” (There was a chorus of 
“ayes” and the motion was carried.) 

I will ask the Secretary to cast one ballot to 
elect Tom Foster President-Elect of this Associa- 
tion 

(The Secretary cast one ballot.) 

Is Dr. Foster here? 

Members: Speech! Speech! 

Dr. Thomas A. Foster, Portland: Mr. President 
and Members of the Convention, I thank you. And 
I accept with gratitude the opportunity of serving 
you in the high office to which you have elected 
me. It seems as though I have known some of the 
members of this Society always, since I can re- 
member. I have known some for a great many 
years, and some for a shorter time. I hope in the 
next two years I will know everybody by name 
and know them as well as I know some of the 
older members. 

I will strive to carry on the traditions of the 
Society in the high standards which have always 
been maintained. I might say to some of you, 
especially those of you who were at Belgrade and 
Bar Harbor, I hope I can make arrangements to 
have a Committee appointed to confer with the 
weather man and next year have blue skies and 
lovely sunshine when we meet. Thank you. (Ap- 
plause.) 

President Bunker: A very fine speech, Tom. I 
think there is nothing more at this time, gentle- 
men. 

Dr. Carter: The meeting of the House of Dele- 
gates. 

President Bunker: A meeting of the House of 
Delegates will take place immediately in the pri- 
vate dining room. 

(Meeting adjourned at 5.15 p. m.) 



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The Journal 

of the 

Maine Medical Association 


Uolume Thirty Portland, Utaine, October, 1939 


No. 10 


The Small Community Hospital as a Teaching Hospital* 

J. T. Morrison, M. D., Kew York City 


I want to preface my remarks today with 
two stories illustrating the search for an idea 
and birth of an ideal. 

Several years ago, when visiting one of the 
hospitals sponsored by the Commonwealth 
Fund, I had occasion to discuss with several 
staff members plans for continuing staff edu- 
cation. We discussed at some length the 
clinical records and the necessity of record- 
ing the events of patient illness in some de- 
tail in order to make them valuable for staff 
study. We discussed fhe use of the labora- 
tory and the X-ray department, autopsies, 
and the development of a minimum standard 
of diagnostic procedure at the hospital. One 
of the staff members remarked that he did 
not see the need for detailed clinical records, 
diagnostic procedures, high percentage of au- 
topsies or Journal Clubs in the small com- 
munity hospital because, after all, it was not 
a teaching hospital. This remark led to quite 
a discussion of the subject of teaching hos- 
pitals. Just what is a teaching hospital and 
why is it a teaching hospital ? And why can- 
not a 50-bed community hospital render a 
service on the firing line, as it were, of medi- 
cal practice such as is rendered by a teaching 
hospital ? 


I continued my inquiries in a number of 
similar hospitals. I found it to be the con- 
sensus of opinion that a teaching hospital is 
a hospital organized for the purpose of 
undergraduate teaching and intern training 
and attached to, or administered by, a medi- 
cal school. Such a hospital is thoroughly 
organized into medical and administrative 
departments, each with its own chief who 
directs its efforts, supervises its work, and 
inspires its teaching activities. The staff at 
such a hospital naturally gives attention to 
the detail of clinical records in order to de- 
velop a basis for medical literature ; estab- 
lishes a minimum standard of diagnostic pro- 
cedure as a guide for those ministering to 
patients : makes detailed laboratory and 

X-ray studies of each patient to support the 
clinical findings and study the effects of dis- 
ease ; arranges for clinical pathological con- 
ferences or staff conferences to pool experi- 
ence; and organizes seminars and journal 
clubs which all staff members must attend. 
All this was considered necessary in a teach- 
ing hospital, as general opinion visualized 
such an institution, in order to teach under- 
graduates and interns the best medical prac- 
tice, the most scientific approach to the study 


* Read at the 87th Annual Session of the Maine Medical Association, Poland Spring, Maine, June 
27. 1939. 


248 


The Journal of the Maine Medical Association 


of illness, and the methods of seeking and ob- 
taining medical information. 

This conception of a teaching hospital 
would not fit the small rural hospital. It laid 
emphasis on a pyramid type of staff organi- 
zation and placed responsibility on the de- 
partment heads for the continued study of 
the art and science of medicine. So I sought 
another lead, and it was not long until I 
found it. A resident physician, bubbling over 
with enthusiasm, remarked to me in discuss- 
ing his work in a small fifty-bed community 
hospital that — and I quote his words — 
“There is so much clinical material available 
at the hospital that I need at least thirty-six 
hours in every day in which to study it, to do 
the patient justice and to make it most valu- 
able to me.” His use of the two concepts, 
clinical material and study, struck me at once 
as fundamental and a real lead in developing 
the teaching ideal as it applies to the small 
hospital. Teaching is based on the study of 
illness. What is there in environment caus- 
ing it and how can it be most successfully 
diagnosed and treated. Therefore, in attack- 
ing these problems a teaching hospital should 
be found wherever there is a patient in a hos- 
pital and wherever there are inquiring minds 
on the staff of physicians attending the pa- 
tient. Following this ideal, staff members 
approaching the study and care of illness 
with the spirit of critical analysis of each 
patient, should be able to make teaching 
material from even the so-called routine 
medical work they are called upon to handle 
in their day-to-day hospital practice. What 
about instructors ? Several universities have 
already recognized that an inquiring mind on 
the battlefront of general practice can con- 
tribute experiences which are valuable in 
teaching. These universities give their under- 
graduates a period of apprenticeship with 
general physicians working as a group in a 
small hospital. What about students ? I do 
not think anyone will take issue with the 
statement that, when we diagnose and care 
for illness in human beings, we are all 
students. 

Let us examine, with this concept of a 
teaching hospital in mind, some of the basic 
features of a small community hospital that 
can make it a teaching hospital. I am refer- 
ring in my discussion to the community type 


of hospital and to a hospital of approxi- 
mately fifty beds. This limitation is made 
largely because this type and size of hospital 
has supplied me with the material for this 
discussion. In a larger sense, however, I am 
referring to any hospital which provides a 
service to all patients and physicians of the 
community and supplies effectively, so far as 
is possible, the variety of services and facili- 
ties and the means for their ready use, which 
contribute to a well rounded medical service 
to the community. 

Medical practice is made up of art and 
science, the whole based on the exercise of 
medical judgment by a trained human being. 
Since the doctor is a human being, the judg- 
ment he brings to the practice of his profes- 
sion is not infallible. He sees a patient and 
discusses the illness with him. He makes a 
physical examination to determine through 
his training and experience the physiological 
changes which have taken place. Having ar- 
rived at a tentative conclusion as to the ill- 
ness, he calls upon laboratory X-ray and 
other aids to support his judgment or to 
suggest another approach to the problem. 
Receiving reports from these technical aids, 
the clinician formulates his conclusion on the 
basis of his past experience and that of others 
and proceeds with his treatment. Subse- 
quently, in quite a number of instances, he 
has the opportunity to observe the effects of 
his treatment and to judge his own work. 
The whole then becomes a part of this indi- 
vidual physician’s experience. 

Since the care of the patient is medical 
practice and the acquisition of experience 
important, one of the most important steps in 
teaching is the pooling of the individual ex- 
perience of each physician with that of others 
in a common fund of knowledge. In the com- 
munity hospital where there are no depart- 
ment heads and the staff organization is hori- 
zontal this can be done best in the hospital 
staff meeting, provided, of course, the staff 
members approach their meeting with the 
spirit of critically analyzing and freely dis- 
cussing their experience. Staff leadership in 
terms of individuals may be officially vested 
in elected chairmen and appointed commit- 
tees, but staff leadership providing the stimu- 
lus for a high quality of medical work is un- 
officially vested in the consensus of opinion 


Volume Thirty, No. IO The Small Community Hospital as a Teaching Hospital 


24 9 


of tlie staff as a group. A concerted will to 
share experience, submerge individual per- 
sonalities, and establish a real give-and-take 
of critical judgment is the only sound basis 
for a teaching hospital. 

Let me illustrate my point by two stories 
from small community hospitals. As I ap- 
proached a certain hospital, a physician came 
through the door almost at a run, “I haven’t 
time to stay and talk now ; I have to do an 
autopsy on a former patient of mine in a 
nearby city. I operated on this patient some 
two weeks ago, and she died at home on the 
second day after her return from the hos- 
pital. Do you think I could come to staff 
meeting without an autopsy report to show 
the cause of death ?” 

In another hospital a physician presented 
the clinical record of one of his patients who 
had been very ill. The patient, a little girl, 
had been admitted to the hospital with a pain 
in her right side. The laboratory report indi- 
cated a very high white count. A diagnosis 
of acute appendicitis was made and an opera- 
tion performed. At operation a normal ap- 
pearing appendix was removed. Subsequent 
examination of the patient disclosed a lobar 
pneumonia of the right side. The patient re- 
covered after a very difficult convalescence. 
This physician wished to present this in- 
stance to the staff in order that they might 
profit by his experience. I may add that fol- 
lowing this experience the staff set up a diag- 
nostic routine requiring an X-ray of the 
chest before operation in every instance of 
suspected abdominal pathology in children 
below the age of fourteen as a measure of 
general protection to future patients and 
themselves from such a happening. 

The hospitals from which these stories are 
taken, to my mind, are teaching hospitals. 
Every physician of the staff is both instruc- 
tor and pupil. 

I have referred above to the diagnostic 
routine established by one staff as a result of 
an adverse experience. The establishment of 
such a. diagnostic standard is another step in 
the development of a teaching hospital. In 
the large teaching hospital devoted to under- 
graduate teaching these standards are re- 
garded as a routine. They describe the de- 
sired contents of the clinical record in each 
general type of illness and list the laboratory 


and X-ray or other more specialized studies 
to be made in each instance. Such a routine 
is a standard for undergraduates, interns, 
residents, and members of the staff to follow 
to assure the patient and physician the most 
complete study of illness, and to protect both, 
as far as is mechanically possible, from 
human error in judgment. In mos